Hydroxocobalamin for treatment of catecholamine-resistant vasoplegia during liver transplantation: A single-center series of 20 cases

Introduction: Catecholamine-resistant vasoplegia is a potentially devastating complication during liver trans-plantation. Hydroxocobalamin has emerged as a treatment for vasoplegia associated with cardiac surgery, liver transplantation, and septic shock.Presentation of case: We performed a retrospective review of patients who underwent liver transplantation be-tween October 2015 and May 2020 to evaluate the efficiency of hydroxocobalamin in this setting.Discussion: A total of 137 patients underwent liver transplantation, of which 20 received hydroxocobalamin for vasoplegia. Administration of hydroxocobalamin increased mean arterial pressure and reduced vasoactive drug requirements. Conclusion: This case series adds to the previous individual reports describing the use of hydroxocobalamin during liver transplantation suggesting hydroxocobalamin can mitigate refractory hypotension from catechol-amine resistant vasoplegia during liver transplantation.