Effect of mannitol on postreperfusion syndrome during living donor liver transplant: A randomized clinical trial

ABSTRACT

Background and aims

Hemodynamic instability during postreperfusion syndrome remains the most significant concern for transplantation teams. Various strategies have been investigated in an attempt to reduce the occurrence of postreperfusion in liver transplantation, including the use of mannitol as a scavenger of free radicals and inflammatory mediators. The study examined mannitol intraoperative antioxidant effect on reperfusion hemodynamic events during living donor liver transplantation (LDLT).

Methodology

This prospective randomized controlled trial divided 60 participants with end-stage liver disease into two groups of 30 participants each. The mannitol group was administered 1 g/kg of mannitol (20%) in a 500-mL labeled bottle (solution A); the control group received the same amount of normal saline (0.9%) in a 500-mL labeled bottle (solution B). The primary outcome was mean arterial pressure (MAP) postreperfusion. Secondary outcomes were recorded after reperfusion: cardiac output (COP), systemic vascular resistance (SVR), the amount of vasopressor administered, central venous pressure (CVP), and urine output (UOP). This study received ethics committee approval (R 42/2022) and was registered at clinicaltrials.gov (NCT05277623).

Results

The MAP parameters were significantly lower in the control group, with MAP<60 mm Hg in 93.3% of the control group versus 40% of the mannitol group (p ˂ 0.001). There was a statistically significant difference regarding SVR (p ˂ 0.001). Norepinephrine levels were lower for the mannitol group compared with controls (p = 0.003). As regards COP, CVP, and UOP there was no statistically significant difference between the two groups.

Conclusion

Mannitol attenuates the postreperfusion syndrome during LDLT.

KEYWORDS:

• Mannitol
• reperfusion
• living
• donor
• liver transplantation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

No financial support is to be disclosed.