F Khalili1, M B Khosravi1, M A Sahmeddini1, M H Eghbal1, K Kazemi2, S Nikeghbalian2, S Ghazanfar Tehran1, B Khosravi3. 1. Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. 2. Shiraz Organ Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. 3. Biostatistics Department, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Abstract
BACKGROUND: Ischemia-reperfusion injury during transplantation can cause post-operative graft dysfunction. OBJECTIVE: To assess the efficacy of N-acetylcysteine in preventing hepatic ischemia-reperfusion injury and post-transplant outcomes. METHODS: In this retrospective study on pediatrics undergoing living-donor (from one of their parents) liver transplantation, N-acetylcysteine was administered to one group (n=20) after induction in the donors until graft harvest, and in the recipients during implantation, which was maintained for 19 hours. The second group (n=20) did not receive NAC. Early allograft dysfunction was determined in the presence of alanine aminotransferase or aspartate aminotransferase ≥2000 IU/L and bilirubin ≥10 mg/dL within the first 7 days, and an international normalized ratio ≥1.6 on day 7. Data were collected from a retrospectively maintained database. RESULTS: The incidence of post-reperfusion syndrome was lower in N-acetylcysteine group compared with the other group (5% vs. 30%, p=0.037). Serum creatinine level was significantly (p=0.04) different in the N-acetylcysteine group during the second post-operative week (0.14 vs. 0.15 mg/dL). There was no significant difference in the incidence of early allograft dysfunction (21% vs. 14%, p=0.327), and the survival rate (p=0.409). CONCLUSION: Peri-operative infusion of N-acetylcysteine in both donor and recipient would effectively prevent post-reperfusion syndrome and renal insufficiency. However, it might not affect the early allograft dysfunction, ICU stay, and mortality. NAC increases the chance of re-operation due to non-surgical bleeding in the first post-operative day.
BACKGROUND: Ischemia-reperfusion injury during transplantation can cause post-operative graft dysfunction. OBJECTIVE: To assess the efficacy of N-acetylcysteine in preventing hepatic ischemia-reperfusion injury and post-transplant outcomes. METHODS: In this retrospective study on pediatrics undergoing living-donor (from one of their parents) liver transplantation, N-acetylcysteine was administered to one group (n=20) after induction in the donors until graft harvest, and in the recipients during implantation, which was maintained for 19 hours. The second group (n=20) did not receive NAC. Early allograft dysfunction was determined in the presence of alanine aminotransferase or aspartate aminotransferase ≥2000 IU/L and bilirubin ≥10 mg/dL within the first 7 days, and an international normalized ratio ≥1.6 on day 7. Data were collected from a retrospectively maintained database. RESULTS: The incidence of post-reperfusion syndrome was lower in N-acetylcysteine group compared with the other group (5% vs. 30%, p=0.037). Serum creatinine level was significantly (p=0.04) different in the N-acetylcysteine group during the second post-operative week (0.14 vs. 0.15 mg/dL). There was no significant difference in the incidence of early allograft dysfunction (21% vs. 14%, p=0.327), and the survival rate (p=0.409). CONCLUSION: Peri-operative infusion of N-acetylcysteine in both donor and recipient would effectively prevent post-reperfusion syndrome and renal insufficiency. However, it might not affect the early allograft dysfunction, ICU stay, and mortality. NAC increases the chance of re-operation due to non-surgical bleeding in the first post-operative day.
Entities:
Keywords:
Ischemic-reperfusion injury; Living donor liver transplantation; N-acetylcysteine
Authors: Robert H Squires; Anil Dhawan; Estella Alonso; Michael R Narkewicz; Benjamin L Shneider; Norberto Rodriguez-Baez; Dominic Dell Olio; Saul Karpen; John Bucuvalas; Steven Lobritto; Elizabeth Rand; Philip Rosenthal; Simon Horslen; Vicky Ng; Girish Subbarao; Nanda Kerkar; David Rudnick; M James Lopez; Kathleen Schwarz; Rene Romero; Scott Elisofon; Edward Doo; Patricia R Robuck; Sharon Lawlor; Steven H Belle Journal: Hepatology Date: 2013-02-04 Impact factor: 17.425
Authors: M B Khosravi; H Sattari; S Ghaffaripour; M Lahssaee; H Salahi; M A Sahmeddini; A Bahador; S Nikeghbalian; S Parsa; S Shokrizadeh; S A Malek-Hosseini Journal: Int J Organ Transplant Med Date: 2010