The efficacy of N-acetylcysteine as a hepatoprotective agent in liver transplantation

Abstract

One of the most common complications after liver transplantation is primary graft dysfunction which results from severe deterioration of the microcirculation. The data obtained from our experimental studies indicate that N-acetylcysteine (NAC) is able to reduce the severity of ischemia/reperfusion injury and improves postoperative graft function after liver transplantation in rats. The aim of this pilot study was to evaluate the efficacy of NAC as a hepatoprotective agent under clinical conditions. A group of 30 liver transplanted patients were treated with NAC, and 30 patients (control group) were treated with a 5 % solution of glucose only. In the NAC group we observed a distinct reduction in ischemia/reperfusion injury and improved liver function with less elevated peak transaminases, better macrocirculation, improved liver synthesis function and a lower incidence of primary nonfunction compared with the control group. We conclude that NAC is a very promising substance for reducing graft dysfunction in clinical liver transplantation.

N-Acetylcysteine Attenuates Bacterial Translocation after Partial Hepatectomy in Rats

“…These authors have concluded that the opening of arteriovenous shunts and the diversion of blood away from the gastrointestinal tract might cause hypoxia. Thies et al [20] observed significantly better portal vein flow in transplanted patients treated with NAC. In the study of Schmidt et al [21], treatment with NAC increased the mesenteric postcapillary flow of the rabbits that received E. coli lipopolysaccharides.…”

Effects of N-acetylcysteine on regeneration following partial hepatectomy in rats with nonalcoholic fatty liver disease

“…4,20 Following encouraging results about the effectiveness of NAC against hepatic ischemia/reperfusion injury in animals with a healthy liver, NAC has been reported to reduce ischemia/reperfusion injury and improve graft function after liver transplantation in humans too. 11,21 However, ischemia/reperfusion injury in a steatotic liver differs from that in a normal liver, with massive necrosis, or uncontrolled cell death, occurring instead of controlled apoptosis. The release of cytoplasmic contents and infl ammation causing systemic injuries such as acute tubular necrosis adversely affects the survival of rats.…”

“…It has been reported that NAC increases liver blood fl ow and has hepatoprotective effects on hepatic ischemia-reperfusion injury by improving hepatic macro-and microcirculation. 10,11 This suggests that NAC could improve impaired regeneration capacity in NAFLD. The antioxidative properties of NAC have been the subject of experimental studies on the treatment of NAFLD, with encouraging results.…”

Bucillamine, a thiol antioxidant, prevents transplantation-associated reperfusion injury

“…N-acetylcysteine, especially at high doses, has been successful in preserving microcirculatory function in some studies but has been ineffective in others (28,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). In a pilot clinical study, it also seemed to improve outcomes in patients (46). A P-selectin antibody has been effective, presumably by preventing or reducing leukocyte infiltration (47).…”