The use of prostaglandins in the immediate postsurgical liver transplant period.
BACKGROUND
Experimental evidence has suggested that prostaglandins have positive effects on hepatic perfusion after transplantation. However, randomized clinical trials have failed to show their usefulness to decrease the incidence of primary nonfunction. In order to demonstrate its therapeutic role, we performed a clinical study in which PGE1 was administered only after the appearance of posttransplant liver dysfunction.


METHODS
Forty patients with macroscopic signs of hypoperfusion or lacking bile production at the end of the operation (n = 24) or with an increase in transaminases and fall in biliary production in the first 24 hours postsurgery (n = 16) were administered alprostadil (PGE1; 0.01 mug/kg/min to the maximum plateau of 0.06 mug/kg/min). We measured the mean values of aspartate aminotransferase (AST), alanine aminotransferase (ALT), activated thromboplastin time-ratio (aPTT-r), international normalized ratio (INR), bilirubin, creatinine and plasma nitrogen, PaO(2)/FiO(2) at the start of the treatment and every 6 hours for 48 hours, and daily diuresis.


RESULTS
There appeared to be a significant decrease in AST, INR, aPTT-r, and creatinine clearance (P < .05), while there was a significant rise in the blood urea nitrogen (P < .001). ALT and bilirubin did not show significant variations. The PaO(2)/FiO(2) ratio showed a significant decrease (P < .001) in pulmonary vasodilatation.


CONCLUSIONS
Prostaglandins used in the manner in our study showed a significant efficiency to improve liver dysfunction after transplantation.
Gatta
A
A
Dipartimento di Discipline Chirurgiche, Rianimatorie e dei Trapianti, Università di Bologna, Italy.
Dante
A
A
Del Gaudio
M
M
Pinna
A D
AD
Ravaioli
M
M
Riganello
I
I
Volta
G
G
Faenza
S
S
D000527:Alprostadil / Q000627:therapeutic use*; D001663:Bilirubin / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011184:Postoperative Period; D013997:Time Factors; D014508:Urea / Q000097:blood
D014508:Urea; D000527:Alprostadil; D001663:Bilirubin; D010100:Oxygen