Prostaglandin E1 administration following orthotopic liver transplantation: a randomized prospective multicenter trial.
OBJECTIVE
Prostaglandin E1 (PGE1) has been used after orthotopic liver transplantation (OLT) based on limited clinical data suggesting PGE1 infusion improves immediate hepatic allograft function. The aim of this study was to conduct a randomized double-blinded multicenter trial to evaluate the effect of PGE1 on early hepatic and renal function in patients undergoing OLT.


METHODS
One hundred eighteen patients were randomized to receive either PGE1 or crystalloid placebo intravenously after allograft revascularization. Primary end points were incidence of primary allograft nonfunction (PNF) or severe renal dysfunction.


RESULTS
The incidence of PNF was 6.7% (4 of 60) and 6.9% (4 of 58) in the control and PGE1 groups, respectively. PGE1 infusion was, however, associated with improved early renal function (mean peak creatinine level of 1.4 +/- 1.0 and 2.0 +/- 1.0 in patients treated with PGE1 and placebo, respectively; P < 0.001). Severe renal dysfunction occurred more frequently in the placebo group (26.7%) than in the PGE1 group (13.8%; P = 0.65). Additionally, dialysis treatments were more frequent in the placebo group (0.7 +/- 2.0 per patient) than in the PGE1 group (0.2 +/- 1.0 per patient; P = 0.10). Initial intensive care unit stay was shorter in patients treated with PGE1 (4.0 +/- 3.6 days) compared with controls (10.5 +/- 17.1 days) (P < 0.01).


CONCLUSIONS
PGE1 administration after OLT resulted in improved renal function and decreased initial postoperative intensive care unit stay but did not affect the incidence of PNF.
Klein
A S
AS
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Cofer
J B
JB
Pruett
T L
TL
Thuluvath
P J
PJ
McGory
R
R
Uber
L
L
Stevenson
W C
WC
Baliga
P
P
Burdick
J F
JF
D000328:Adult; D000527:Alprostadil / Q000009:adverse effects / Q000627:therapeutic use*; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D000077324:Crystalloid Solutions; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007362:Intensive Care Units; D007552:Isotonic Solutions; D007902:Length of Stay; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage; D011182:Postoperative Care; D011446:Prospective Studies; D015532:Rehydration Solutions / Q000008:administration & dosage; D016896:Treatment Outcome
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D015532:Rehydration Solutions; D003404:Creatinine; D000527:Alprostadil