To Assess the Efficacy of Midodrine In Prevention Of Cirrhosis Related Complications In Children Awaiting Liver Transplantation -A Randomized Controlled Trial

Background and Aim: Release of damage associated molecular patterns pathogen in cirrhotics lead to splanchnic vasodilatation renin angiotensin aldosterone system (RAAS) activation ultimately resulting development various complications related cirrhosis. Midodrine, an alpha-1 adrenergic agonist, causes vasoconstriction counteracting arterial hypovolemia inhibiting RAAS activation. We conducted this randomized controlled trial (RCT) determine the efficacy midodrine preventing children with decompensated cirrhosis awaiting liver transplantation (LT) Methods: Thirty-five consecutive cirrhotic LT were receive either additional or standard medical therapy (SMT) alone for 6 months. Oral started at 0.25mg/kg/day titrated a maximum dose 0.5mg/kg/day based on increase mean pressure. Results: A total 35 subjects 18 into arm 17 SMT arm. All baseline parameters including disease severity scores comparable 2 groups except higher creatinine (0.35mg/dl vs 0.24mg/dl, p =0.045). Patients had lower incidence new onset acute kidney injury (AKI) (OR: 0.10, 95% CI: 0.02-0.50, p=0.005) hyponatremia 0.167, 0.03-0.81, p=0.032), along greater resolution pre-existing as compared patients receiving SMT. There was estimated glomerular filtration rate 1 months Midodrine led reduction plasma activity (PRA) 3 while PRA increased no difference ascites resolution, recurrence ascites, episodes spontaneous bacterial peritonitis, hepatic encephalopathy native survival. Conclusion: lowers AKI by decreasing