Haemodynamic Effects of a Long-Acting Somatostatin Analogue in Patients with Liver Cirrhosis

Abstract

The influence of SMS 201-995 (octreotide, Sandostatin®), a long-acting somatostatin analogue, on splanchnic haemodynamics was studied in 15 patients with liver cirrhosis and in 5 healthy individuals before, during, and after 60min of intravenous SMS infusion (25 and 50μg/h, respectively). No adverse effects of the SMS infusion were seen. In the basal state the estimated hepatic blood flow was 1.04 ± 0.08l/min (mean ± SE) in the patients and 1.62 ± 0.09 I/min (P < 0.001) in the controls. At 15 min after the beginning of the infusion the blood flow had already decreased by 15–30% (P < 0.054.01). The reduction was more marked in controls than in patients, and it persisted in both groups during and for 60 min after the infusion. Wedged hepatic venous pressure, measured in the patients, was 20 k 2mmHg in the basal state and 18 ± 1 mmHg during the infusion (P < 0.05), and it remained at this level for 60 min after the infusion. Free hepatic venous pressure was unchanged throughout the study. Splanchnic oxygen uptake was similar in the two groups in the basal state and remained unaltered during and after SMS infusion. Both heart rate and arterial systolic and diastolic blood pressure remained unchanged during SMS administration. In summary, SMS infusion results in a fall in hepatic blood flow and a slight bur significant decrease in wedged hepatic venous pressure, whereas no effect was noted on the systemic circulation. In view of these findings, clinical trials to determine the efficacy of SMS administration in patients with portal hypertension and bleeding oesophageal varices are warranted.

Key Words:

• Blood flow
• hepatic
• hypertension
• liver cirrhosis
• oesophageal varices
• portal venous pressure
• somatostatin analogue
• venous pressure
• wedged hepatic