Background: Fospropofol disodium for injection (FospropofolFD) is a novel water-soluble propofol prodrug metabolized by alkaline phosphatase (ALP). In contrast to propofol, it demonstrates superior hemodynamic stability and reduced lipid metabolism-related adverse effects in patients with normal hepatic function. These characteristics hold particular significance for liver transplant recipients with decompensated cirrhosis, who frequently exhibit hemodynamic instability and impaired lipid homeostasis. However, clinical evidence supporting the use of FospropofolFD in this high-risk population remains lacking. This case series aims to evaluate the potential advantages of FospropofolFD for anesthesia induction in liver transplant recipients with Child-Pugh B/C cirrhosis.
Methods: In this prospective observational study, three cirrhotic patients (Model for End-stage Liver Disease scores: 22-38) were administered FospropofolFD-based induction (10 mg/kg) during liver transplantation. Hemodynamics, bispectral index (BIS), and perioperative organ function were monitored.
Results: All patients achieved rapid induction (≤1 minute) with stable hemodynamics (mean arterial pressure ≥60 mm Hg) and BIS <60. No intraoperative hypoxemia or delayed awakening occurred. Postoperative hepatic/renal function remained stable, with extubation completed ≤10 minutes. Diverging from reports in non-cirrhotic cohorts, we found that ALP levels did not correlate with BIS trends, suggesting multifactorial influences on pharmacokinetics in end-stage liver disease.
Conclusion: Although these findings highlight FospropofolFD's potential as a lipid-free alternative to propofol in high-risk liver transplant settings, the observational design and small sample size (n = 3) warrant further validation through randomized controlled trials to establish dosing protocols and confirm safety and efficacy.
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