Use of N -acetylcysteine during liver procurement: A prospective randomized controlled study
| Autor: | Giacomo Zanus, Rafael Morales, Francesco D'Amico, Amedeo Carraro, Pasquale Bonsignore, F.E. D'Amico, Donatella Piovan, Domenico Bassi, E. Lodo, Enrico Gringeri, Alessandra Bertacco, Michele Valmasoni, Alberto Brolese, Daniele Neri, Alessandro Vitale, Greta Garbo, Anna Chiara Frigo, Martina Gambato, M. Scopelliti, Umberto Cillo |
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| Rok vydání: | 2012 |
| Předmět: |
Transplantation
medicine.medical_specialty Hepatology business.industry Proportional hazards model medicine.medical_treatment Hazard ratio Liver transplantation Chronic liver disease medicine.disease Gastroenterology Surgery law.invention Randomized controlled trial law Internal medicine medicine Clinical endpoint business Prospective cohort study Liver preservation |
| Zdroj: | Liver Transplantation. 19:135-144 |
| ISSN: | 1527-6465 |
| DOI: | 10.1002/lt.23527 |
| Popis: | Antioxidant agents have the potential to reduce ischemia/reperfusion damage to organs for liver transplantation (LT). In this prospective, randomized study, we tested the impact of an infusion of N-acetylcysteine (NAC) during liver procurement on post-LT outcomes. Between December 2006 and July 2009, 140 grafts were transplanted into adult candidates with chronic liver disease who were listed for first LT, and according to a sequential, closed-envelope, single-blinded procedure, these patients were randomly assigned in a 1/1 ratio to an NAC protocol (69 patients) or to the standard protocol without NAC [71 patients (the control group)]. The NAC protocol included a systemic NAC infusion (30 mg/kg) 1 hour before the beginning of liver procurement and a locoregional NAC infusion (300 mg through the portal vein) just before cross-clamping. The primary endpoint was graft survival. The graft survival rates at 3 and 12 months were 93% and 90%, respectively, in the NAC group and 82% and 70%, respectively, in the control group (P = 0.02). An adjusted Cox analysis showed a significant NAC effect on graft survival at both 3 months [hazard ratio = 1.65, 95% confidence interval (CI) = 1.01-2.93, P = 0.04] and 12 months (hazard ratio = 1.73, 95% CI = 1.14-2.76, P ≤ 0.01). The incidence of postoperative complications was lower in the NAC group (23%) versus the control group (51%, P 1.8), the incidence of primary dysfunction of the liver was lower (P = 0.09) for the NAC group (15%) versus the control group (32%). In conclusion, the NAC harvesting protocol significantly improves graft survival. The effect of NAC on early graft function and survival seems higher when suboptimal grafts are used. |
| Databáze: | OpenAIRE |
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