Efficacy and safety of terlipressin infusion during liver surgery: a meta-analysis

Although numerous studies have investigated terlipressin (TP) administration in liver surgery to mitigate bleeding, its efficacy remains controversial. This meta-analysis evaluates the effects of TP on estimated blood loss (EBL), blood transfusion requirements, and patient outcomes. We systematically searched PubMed, EMBASE, Cochrane Library, and Web of Science (WOS) for studies on perioperative TP use in liver surgery from their inception through February 2024. Only English-language publications were included. Primary outcomes included EBL and allogeneic blood transfusion volume. Twelve studies involving 988 eligible subjects were included. No significant differences were observed in EBL (weighted mean difference [WMD] =  - 99.09; 95% confidence interval [CI], - 318.41 to 120.24; P = 0.38), red blood cell (RBC) transfusion volume (standardized mean difference [SMD] =  - 0.10; 95% CI =  - 0.74 to 0.54; P = 0.76), or fresh frozen plasma (FFP) transfusion volume (SMD = 0.07; 95% CI =  - 0.24 to 0.37; P = 0.67). Subgroup analysis demonstrated that continuous TP infusion significantly reduced intraoperative EBL (WMD =  - 336.22; 95% CI =  - 562.13 to - 110.31; P = 0.004). TP infusion does not reduce intraoperative EBL or allogeneic blood transfusion requirements in liver surgery. However, continuous TP infusion may lower EBL.PROSPERO registration number: CRD42023450333.