Preoperative Midodrine Use Does Not Predict Intraoperative HypotensionDuring Orthotopic Liver Transplantation

Background: Complications of liver transplantation undermine long term benefits for patients with end-stage liver disease. Some patients awaiting liver transplantation are treated with midodrine, an oral α1 agonist. We hypothesized that preoperative use of midodrine would predict increased intraoperative hypotension with associated vasopressor and blood product administration and deleterious effects on graft survival. Methods: We performed a retrospective, matched case control study examining patients receiving midodrine versus those not before undergoing liver transplantation. Sixty-four patients were examined and analyzed. Primary outcomes were total intraoperative vasopressor use and minutes of intraoperative hypotension. Results: For the primary outcomes, no statistically significant difference was found between the groups. No significant differences were seen in one year patient or graft survival. Statistically significant differences were noted in American Society of Anesthesiologists (ASA) physical status, Model for End-Stage Liver Disease (MELD) scores, preoperative blood pressure metrics, use of continuous renal replacement therapy intraoperatively, cryoprecipitate, and cell saver use. Conclusions: Preoperative use of midodrine in patients undergoing liver transplantation did not predict increased intraoperative hypotension or concomitant need for vasopressors or blood products. Midodrine use was associated with higher ASA and MELD scores, renal replacement therapy, and decreased preoperative blood pressure, but not altered graft survival.