*Purpose: Acute kidney injury (AKI) after liver transplantation precludes calcineurin inhibitors’ therapy and is associated with poor outcomes. Terlipressin (Tp) has mortality benefit in pre-transplant patients with AKI; however, the data on perioperative use of Tp and its effect on post-transplant outcomes has not been systematically reviewed.

*Methods: A comprehensive search of electronic databases from 2000/01/01 to 2020/10/31 was performed. Studies reporting the use of Tp in the perioperative period were included. We considered the random model risk ratio (RR) as the primary result unless I²<50%. The primary aim was to assess the risk of AKI post-transplant. The secondary was to assess the need for renal replacement therapy (RRT), vasopressors, blood loss during surgery, hospital stay, and in-hospital mortality.

*Results: A total of nine studies reporting 711 patients undergoing LDLT were included for analysis. Males-83%. Tp was given for a mean duration of 53.44±28.61 hours post-surgery. Tp reduced the risk of post-transplant AKI by 60% (RR-0.6; 95%CI-0.44-0.8; p=0.001) among 166 patients who received Tp compared to 269 control (C) patients among four studies (I²=0; p=0.45) (Fig. A). Need of RRT was similar in Tp (n=135) and C (n=238) group (RR-0.75 (0.35-1.56); p=0.44) among 3 studies (I²=0; p=0.75). Tp therapy reduced the risk of vasopressor use by 33% (0.24-0.47; p<0.001) among six studies (I²=3.12; p=0.39), which reported 240 patients in the Tp group and 342 in the control group. (Fig. B) Blood loss was similar in both groups (-302.12 ±215.32; p=0.16) among four studies (I²=43.16; p=0.15) which reported. There was no mortality benefit with Tp [RR-1.08 (0.48-2.42);p=0.84)] among two articles, which reported in-hospital mortality among 147 and 242 patients in T and C groups, respectively. Mean hospital stay was also similar in both groups [-0.94 (-2.24 to 0.35) ;p=0.15] among 4 studies (I²=52.5; p=0.09) which reported hospital stay among 424 patients. Mean ICU stay was also similar in both the groups [0.08 (0.42 to 0.18) ;p=0.84] among 4 studies (I²=82.83; p<0.001) which reported 465 patients. Only one study reported adverse events (bradycardia) to Tp.

*Conclusions: Perioperative Tp therapy reduces the risk of post-transplant AKI and the need for vasopressor treatment. However, its use is not associated with a reduction in hospital stay, need for RRT, or mortality. Future extensive, randomized studies are required to assess the beneficial role of Tp on post-transplant outcomes.

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