Use of hydroxocobalamin to treat intraoperative vasoplegic syndrome refractory to vasopressors and methylene blue during liver transplantation

Introduction For patients with catecholamine‐resistant vasoplegic syndrome (VS) during liver transplantation (LT), treatment with methylene blue (MB) and/or hydroxocobalamin (B12) has been an acceptable therapy. However, data on the effectiveness of B12 is limited to case reports and case series. Me...

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Bibliographic Details
Published in:Clinical transplantation 2024-03, Vol.38 (3), p.e15271-n/a
Main Authors: Pai, Sher‐Lu, Torp, Klaus D., Insignares, Vianca C., DeMaria, Samuel, Giordano, Chris R., Logvinov, Ilana I., Li, Zhuo, Chadha, Ryan, Aniskevich, Stephen
Format: Article
Language:English
Subjects:
cardiovascular disease
Humans
hydroxocobalamin
Hydroxocobalamin - therapeutic use
liver transplantation
Liver Transplantation - adverse effects
methylene blue
Methylene Blue - therapeutic use
Retrospective Studies
Vasoconstrictor Agents
vasoplegia
Vasoplegia - drug therapy
Vasoplegia - etiology
vasoplegic syndrome
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Summary:Introduction For patients with catecholamine‐resistant vasoplegic syndrome (VS) during liver transplantation (LT), treatment with methylene blue (MB) and/or hydroxocobalamin (B12) has been an acceptable therapy. However, data on the effectiveness of B12 is limited to case reports and case series. Methods We retrospectively reviewed records of patients undergoing LT from January 2016 through March 2022. We identified patients with VS treated with vasopressors and MB, and ed hemodynamic parameters, vasopressor requirements, and B12 administration from the records. The primary aim was to describe the treatment efficacy of B12 for VS refractory to vasopressors and MB, measured as no vasopressor requirement at the conclusion of the surgery. Results One hundred one patients received intraoperative VS treatment. For the 35 (34.7%) patients with successful VS treatment, 14 received MB only and 21 received both MB and B12. Of the 21 patients with VS resolution after receiving both MB and B12, 17 (89.5%) showed immediate, but transient, hemodynamic improvements at the time of MB administration and later showed sustained response to B12. Conclusion Immediate but transient hemodynamic response to MB in VS patients during LT supports the diagnosis of VS and should prompt B12 administration for sustained treatment response.
ISSN:0902-0063
1399-0012
DOI:10.1111/ctr.15271