Angiotensin II in Liver Transplantation

Launched by UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · May 20, 2021

Keywords

ClinConnect Summary

This clinical trial is investigating the use of a medication called Angiotensin II during liver transplantation. The goal is to find out if this drug can safely and effectively help raise blood pressure for patients who may experience low blood pressure during the surgery. This study is currently looking for participants aged 18 and older who are receiving a liver from a deceased donor and need additional support from a drug called norepinephrine to maintain their blood pressure during the operation.

To be eligible, participants must have a certain level of liver disease severity, indicated by a score of 25 or higher. However, there are specific conditions that would exclude someone from participating, such as having a living donor liver transplant or certain heart and lung issues. If someone joins the trial, they can expect to receive either the Angiotensin II treatment or standard care during their liver transplant, and the researchers will closely monitor their health and safety throughout the process. This study is important because it could lead to better management of blood pressure during liver transplants, potentially improving outcomes for patients undergoing this critical surgery.

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Eligibility criteria

• Inclusion Criteria:
• • Age \> or = 18 years
• • Liver transplantation from a deceased donor
• • Model for End-stage Liver Disease Sodium (MELD-Na) score \> or = 25 at the time of transplant (not counting MELD exception points)
• • Patient requiring \> 0.05 mcg/kg/min of norepinephrine (NE) during LT
• Exclusion Criteria:
• • Living-donor liver transplantation (LDLT)
• • Split liver transplantation (isolated right or left lobe)
• • Donation after cardiac death (DCD) without normothermic machine perfusion (NMP)
• • Acute liver failure (ALF)
• • Listed for or receiving simultaneous liver-kidney transplantation (SLKT)
• • Liver re-transplantation (patient who has previously received a liver transplant)
• • Preoperative treatment with angiotensin II receptor blocker or angiotensin converting enzyme inhibitor (within 48 h)
• • Portopulmonary hypertension
• • Left ventricular systolic dysfunction (defined as ejection fraction \< 45%)
• • Active bronchospasm at time of LT
• • History of thrombotic or embolic disease, inherited hypercoagulable disorder, or therapeutic anticoagulation
• • Portal vein thrombosis
• • Celiac stenosis
• • End-stage renal disease (chronic eGFR \< 15 mL/min/1.73 m2 or chronic RRT - not including AKI requiring RRT)
• • History of Raynaud's disease
• • Known history of allergy to synthetic human angiotensin II
• • Subject intubated and/or mechanically ventilated prior to entering OR for LT
• • Presence of other condition or abnormality that would compromise the safety of the patient or quality of the data