Intraoperative Terlipressin During Liver Transplantation Is Associated with Reduced Vasoactive Requirements and Lower Postoperative Troponin Release

Background/Objectives: Intraoperative hemodynamic instability during liver transplantation (LT) is common and results from cirrhosis-related circulatory dysfunction and profound hemodynamic changes during graft reperfusion. High catecholamine requirements may contribute to secondary organ injury, including myocardial damage. Terlipressin, a selective vasopressin V1 receptor agonist, has been shown to improve hemodynamic stability during LT; however, the impact of a short, targeted intraoperative infusion on cardiac biomarkers remains unclear. Methods: This retrospective single-center study included adult patients undergoing elective orthotopic liver transplantation between May 2017 and December 2025. Emergency transplantations and retransplantations were excluded. All transplant procedures were performed by a single transplant surgeon, while anesthesia care was provided by multiple teams following standardized institutional protocols. Patients receiving a fixed intraoperative dose of terlipressin (0.85 mg administered over 10 min after portal vein clamping; n = 61) were compared with a control group not receiving terlipressin (n = 44). The primary outcome was the vasoactive-inotropic score (VIS), assessed intraoperatively and during the first three postoperative days. Secondary outcomes included postoperative high-sensitivity troponin I (Hs-TnI) concentrations measured on the day of surgery and on postoperative days 1 and 3. Results: Baseline demographic and clinical characteristics, including liver disease severity and baseline Hs-TnI, were comparable between groups. VIS values were significantly lower in the terlipressin group on the day of transplantation (14.3 ± 2.4 vs. 37.0 ± 5.0, p < 0.001) and on postoperative day 1 (10.4 ± 2.2 vs. 17.3 ± 3.4, p < 0.05). Differences were no longer significant on postoperative days 2 and 3. Postoperative Hs-TnI concentrations were significantly lower in the terlipressin group at all assessed time points, including day 0 (51.5 ± 11.3 vs. 150.4 ± 29.0 ng/L, p < 0.001), postoperative day 1 (124.7 ± 28.8 vs. 275.0 ± 74.0 ng/L, p < 0.05), and day 3 (51.1 ± 18.4 vs. 167.2 ± 54.2 ng/L, p < 0.05). Conclusions: In this retrospective cohort, intraoperative terlipressin administration was associated with lower perioperative vasoactive requirements and reduced postoperative troponin release. These findings suggest that targeted terlipressin administration during liver transplantation may contribute to improved perioperative hemodynamic stability. Prospective randomized studies are required to confirm these observations and determine their impact on clinically relevant outcomes.