title: Prostaglandins for adult liver transplanted patients.
abstract: BACKGROUND
  Prostaglandins may reduce ischaemic injury after liver transplantation. Several small randomised trials have evaluated the effects of prostaglandins in patients undergoing liver transplantation. Results of these trials are inconsistent, and none has enough power to reliably exclude effects of prostaglandins.
  
  
  OBJECTIVE
  To assess the benefits and harms of prostaglandin E1 or E2 in adult liver-transplanted patients.
  
  
  METHODS
  We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and LILACS (search on 20 April 2011). In addition, we perused the reference lists of the identified studies and contacted trials investigators, and national and international experts in order to identify more trials for the review.
  
  
  METHODS
  We included randomised clinical trials evaluating prostaglandin E1 or E2 initiated in the perioperative period versus placebo or standard treatment for adult patients undergoing liver transplantation. We did not apply any language or publication status restrictions.
  
  
  METHODS
  Two authors independently evaluated methodological quality, ie, risk of bias of the included trials, and extracted data using standardised data extraction forms. We contacted trial investigators in attempt to retrieve information not available in the original manuscripts. We used random-effects model meta-analyses and fixed-effect model meta-analyses to estimate the odds ratio with 95% confidence interval (CI).
  
  
  RESULTS
  We included ten trials in which 652 patients were randomised. The risk of bias was considered high in most trials. There was no significant effect of prostaglandins on all-cause mortality (37/298[12.4%] in prostaglandin group versus 47/312[15.1%] in control group; OR 0.84, 95% CI 0.53 to 1.37; I(2) = 0%), on primary non-function of the allograft (8/238 [3.4%] versus. 16/250[6.4%] ;OR 0.55, 95% CI 0.23 to 1.33; I(2) = 0%), and on liver re-transplantation (12/161[7.5%] versus 14/171[8.2%]; OR 0.99, 95% CI 0.44 to 2.25; I(2) = 0%). Prostaglandins seemed to significantly decrease the risk of acute kidney failure requiring dialysis (13/158[8.2%] versus 34/171[9.9%]; OR 0.37, 95% CI 0.18 to 0.75; I(2) = 0%). There was no significant increase in the risk of adverse events with prostaglandins.
  
  
  CONCLUSIONS
  We found no evidence that the administration of prostaglandins to liver transplanted patients reduces the risk of death, primary non-function of the allograft, or liver re-transplantation. Prostaglandins might reduce the risk of acute kidney failure requiring dialysis, but the quality of the evidence is considered only moderate due to high risk of bias in most of the included trials. Moreover, there are risks of outcome measure reporting bias and random errors. Therefore, further randomised, placebo-controlled trials are deemed necessary.
authors.affiliation: Education and Research Institute, Hospital do Coração, São Paulo, Brazil. alexandrebiasi@hotmail.com.
authors.forename: Alexandre B
authors.initials: AB
authors.lastname: Cavalcanti
authors.forename: Camila Paiva
authors.initials: CP
authors.lastname: De Vasconcelos
authors.forename: Mariana
authors.initials: M
authors.lastname: Perroni de Oliveira
authors.forename: Edna T
authors.initials: ET
authors.lastname: Rother
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ferraz
mesh_terms: D058186:Acute Kidney Injury / Q000517:prevention & control*; D000328:Adult; D000527:Alprostadil / Q000031:analogs & derivatives / Q000627:therapeutic use*; D002423:Cause of Death; D015232:Dinoprostone / Q000627:therapeutic use*; D011464:Epoprostenol / Q000627:therapeutic use; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D055031:Primary Graft Dysfunction / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation / Q000706:statistics & numerical data; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D011464:Epoprostenol; D000527:Alprostadil; C054594:enisoprost; D015232:Dinoprostone