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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2016; 22(4): 1582-1592
Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1582
Modulation of splanchnic circulation: Role in perioperative management of liver transplant patients
Ahmed Mukhtar, Hany Dabbous
Ahmed Mukhtar, Department of Anesthesia and Critical Care, Cairo University, Cairo 11562, Egypt
Hany Dabbous, Department of Hepatology and Gastroenterology, Ain Shams University, Cairo 11566, Egypt
Author contributions: Mukhtar A contributed to the design of the review, as well as writing, revision, and final approval of the manuscript; Dabbous H contributed to writing, revision, and final approval of the manuscript.
Conflict-of-interest statement: The contributing authors have no conflicts of interest regarding the writing or publication of this minireview.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ahmed Mukhtar, MD, Professor, Department of Anesthesia and Critical Care, 1 Al-Saray Street, Al-Manial, Cairo University, Cairo 11562, Egypt. ahmed.mukhtar@kasralainy.edu.eg
Telephone: +2-11-14208444 Fax: +2-22-3641687
Received: April 29, 2015
Peer-review started: May 7, 2015
First decision: July 20, 2015
Revised: August 13, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: January 28, 2016
Abstract

Splanchnic circulation is the primary mechanism that regulates volumes of circulating blood and systemic blood pressure in patients with cirrhosis accompanied by portal hypertension. Recently, interest has been expressed in modulating splanchnic circulation in patients with liver cirrhosis, because this capability might produce beneficial effects in cirrhotic patients undergoing a liver transplant. Pharmacologic modulation of splanchnic circulation by use of vasoconstrictors might minimize venous congestion, replenish central blood flow, and thus optimize management of blood volume during a liver transplant operation. Moreover, splanchnic modulation minimizes any high portal blood flow that may occur following liver resection and the subsequent liver transplant. This effect is significant, because high portal flow impairs liver regeneration, and thus adversely affects the postoperative recovery of a transplant patient. An increase in portal blood flow can be minimized by either surgical methods (e.g., splenic artery ligation, splenectomy or portocaval shunting) or administration of splanchnic vasoconstrictor drugs such as Vasopressin or terlipressin. Finally, modulation of splanchnic circulation can help maintain perioperative renal function. Splanchnic vasoconstrictors such as terlipressin may help protect against acute kidney injury in patients undergoing liver transplantation by reducing portal pressure and the severity of a hyperdynamic state. These effects are especially important in patients who receive a too small for size graft. Terlipressin selectively stimulates V1 receptors, and thus causes arteriolar vasoconstriction in the splanchnic region, with a consequent shift of blood from splanchnic to systemic circulation. As a result, terlipressin enhances renal perfusion by increasing both effective blood volume and mean arterial pressure.

Keywords: Splanchnic circulation, Vasopressin agonists, Portal blood flow, Liver transplant, Perioperative renal function

Core tip: Perioperative modulation of splanchnic circulation may be beneficial when managing liver transplant recipients. The possible benefits include improved maintenance of central blood volume and renal perfusion, and minimization of high portal flow in small for size livers. Terlipressin is a promising drug candidate for use as a splanchnic modulator.