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

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.

Automated summary

This study aimed to investigate the antioxidant effect of mannitol during reperfusion hemodynamic events in living donor liver transplantation. The results showed that the mannitol group had significantly higher mean arterial pressure and lower systemic vascular resistance and norepinephrine levels compared to the control group. There was no significant difference in cardiac output, central venous pressure, and urine output between the two groups. Therefore, mannitol can attenuate the postreperfusion syndrome during LDLT.