Introduction Adrenal insufficiency is associated with increased fluid and vasopressor requirements in liver failure and treatment with hydrocortisone improves survival in cirrhotic patients with septic shock.1 Previous data from our unit suggest a high incidence of adrenal insufficiency in patients undergoing liver transplant (LT).2 Adrenal insufficiency appears to be more common in liver transplant programs that use steroid free immunosuppressive regimens but the effect of intraoperative corticosteroids on the outcome of liver transplantation has never been assessed.3
Methods We conducted a retrospective analysis of prospectively collected data from 90 consecutive patients undergoing first elective LT, before (Group 1 n=45) and after (Group 2-n=45) the administration of 1000 mg methylprednisalone in the anhepatic phase became standard practise. No other changes to LT treatment protocols were made during the study period. Baseline demographic data and post operative requirements for fluids (12 h and total ITU crystalloid and colloid requirement), vasopressors, renal replacement therapy, ventilation and total stay on the intensive care unit (ITU) were compared between groups.
Results Indication, MELD score and age at time of LT were not significantly different between groups. There were significantly reduced requirements for fluid, vasopressors, renal replacement therapy, invasive ventilation and ITU stay in group 2 compared with group 1.
Conclusion Compared to patients undergoing LT in a steroid free regimen, the adminstration of intrapoerative methylprednisolone to patients undergoing LT results in improved post operative haemodynamics and the need for organ support. This finding supports the notion that the common finding of adrenal insufficiency in patients with cirrhosis has clinical importance and that corticosteroid replacement can improve outcome.
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