Perioperative prostaglandin e1 infusion in living donor liver transplantation: A double‐blind, placebo‐controlled randomized trial

Abstract

The role of prostaglandin E1 (PGE1) infusion in improving early graft function has not been well defined, especially in the scenario of living donor liver transplantation (LDLT). We designed a randomized, double-blind, placebo-controlled trial to evaluate the role of perioperative PGE1 infusion in LDLT. Patients in the study arm received PGE1 (alprostadil) at the rate of 0.25 μg/kg/hour, starting at 1 hour after portal venous reperfusion, and continued for 96 hours. The primary endpoint was early allograft dysfunction (EAD). We analyzed multiple secondary endpoints including postoperative liver function and renal function parameters, acute kidney injury (AKI), hepatic artery thrombosis (HAT), postoperative bleeding, overall mortality, and posttransplant hospital stay. The incidence of EAD was lower in the PGE1 arm, although the difference did not reach statistical significance (22.4% versus 36%; P = 0.21). Among the secondary endpoints, the incidence of AKI was significantly lower in the PGE1 arm (8.2% versus 28%; P = 0.02), as were the peak and mean postoperative creatinine levels. The need for renal replacement therapy was similar between the 2 groups. Among the postoperative graft function parameters, postoperative alanine aminotransferase level was significantly lower in the PGE1 arm (P = 0.04), whereas the remaining parameters including serum bilirubin, aspartate aminotransferase, and international normalized ratio were similar between the 2 arms. There was no difference in the incidence of HAT and postoperative bleeding, in-hospital mortality, and posttransplant hospital stay between the 2 arms. Perioperative PGE1 infusion reduces the incidence of posttransplant renal dysfunction in patients undergoing LDLT. Liver Transplantation 22 1067-1074 2016 AASLD.

Antegrade Hepatic Artery and Portal Vein Perfusion Versus Portal Vein Perfusion Alone in Living Donor Liver Transplantation: A Randomized Trial

“…First, the occurrence of HAT was slightly higher in this trial cohort, especially in the control population. Indeed, this is more than our routine rate of 2% . The reason for this is not evident.…”

“…Indeed, this is more than our routine rate of 2%. (19) The reason for this is not evident. Despite this, it is noteworthy that the occurrence of HAT was <2% in the group that received arterial perfusion.…”

Ischaemia reperfusion injury in liver transplantation: Cellular and molecular mechanisms

“…Unfortunately, neither has shown promise in clinical trials. PGE‐2 administration in liver transplantation has no effect on the rates of allograft dysfunction or patient survival . Data for the effectiveness of PGI‐2 are similarly lacking …”

Anaesthetic implications and transfusion practices in ABO incompatible living donor liver transplantation

“…[ 3 9 ] Prostaglandin E 1 also decreases the cell mediated cytotoxicity against the hepatocytes and enhances the level of DNA synthesis in cell by stimulating the cyclic adenosine monophosphate production and increasing the ATP level in hepatic tissue. [ 10 ] All our patients included had infusions of Prostaglandin E 1 administered intravenously at 0.25 µg/kg/h that we believed could enhance graft blood flow.…”