title: 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.
authors.affiliation: Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Viju Kumar
authors.initials: VK
authors.lastname: Bharathan
authors.affiliation: Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Biju
authors.initials: B
authors.lastname: Chandran
authors.affiliation: Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Unnikrishnan
authors.initials: U
authors.lastname: Gopalakrishnan
authors.affiliation: Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Christi Titus
authors.initials: CT
authors.lastname: Varghese
authors.affiliation: Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Ramachandran N
authors.initials: RN
authors.lastname: Menon
authors.affiliation: Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Balakrishnan
authors.affiliation: Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: O V
authors.initials: OV
authors.lastname: Sudheer
authors.affiliation: Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Puneet
authors.initials: P
authors.lastname: Dhar
authors.affiliation: Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Sudhindran
authors.initials: S
authors.lastname: Surendran
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D064591:Allografts / Q000187:drug effects*; D000527:Alprostadil / Q000008:administration & dosage / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006499:Hepatic Artery / Q000473:pathology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D020011:Protective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology
chemical_list: D020011:Protective Agents; D003404:Creatinine; D000527:Alprostadil