Influencia del propranolol preoperatorio en el índice cardíaco durante la fase anhepática del trasplante hepático

Abstract

Introduction

Liver transplantation (LT) is the best therapeutic option for end-stage liver disease. Non-selective beta-blocker medications such as propranolol act directly on the cardiovascular system and are often used in the prevention of gastrointestinal bleeding resulting from portal hypertension. The effects of propranolol on cardiovascular system of cirrhotic patients during LT are not known.

Objective

Evaluate the influence of propranolol used preoperatively on cardiac index (CI) during the anhepatic phase of LT.

Method

One hundred and one adult patients (73 male [72.2%]) who underwent cadaveric donor orthotopic liver transplantation by piggyback technique with preservation of the retrohepatic inferior vena cava performed at Hospital das Clínicas, Federal University of Minas Gerais were evaluated. There was no difference in severity between groups by the Meld system, P = .70. The preoperative use of propranolol and the CI outcome were compared during the anhepatic phase of LT in 5 groups (I: increased CI, II: CI reduction < 16%, III: CI reduction ≥ 16% and  < 31%, IV: CI reduction ≥ 31% and  < 46%, V: CI reduction equal to or greater than 46%).

Results

Patients in group I (46.4%) who received propranolol preoperatively were statistically similar to groups II (60%), III (72.7%), IV (50%) and V (30.8%), P = .57.

Conclusion

The use of propranolol before transplantation as prophylaxis for gastrointestinal bleeding may be considered safe, as it was not associated with worsening of CI in anhepatic phase of LT.