The Role of Methylene Blue and Cyanocobalamin for Vasoplegic Syndrome in Liver Transplantation

Vasoplegic syndrome is a complication that may occur during liver transplantation, most often after donor graft reperfusion. Multiple factors in end-stage liver disease (ESLD) may contribute to this vasodilation which may be exacerbated during reperfusion in liver transplantation. Two cases of vasoplegia during living donor liver transplantation are reported along with a systematic review of current literature. These patients were successfully treated with methylene blue and cyanocobalamin. All publications between January 1992 to september 2024 that assessed the use of methylene blue and/or cyanocobalamin in vasoplegia during liver transplantation in humans were included. Seven case reports and one case series were found and reviewed. These consisted of 4 case reports of vasoplegic syndrome during liver transplantation treated with methylene blue and other four describing the use of cyanocobalamin. A total of twenty-four patients were treated with methylene blue and eight patients with cyanocobalamin in the reviewed articles and all patients had a beneficial impact on blood pressure after administration of the medications. Patients affected by vasoplegia during liver transplantation show encouraging results when treated with methylene blue and cyanocobalamin, but these data have to be confirmed by additional studies.