Perioperative N-acetylcysteine for patients undergoing livingdonor orthotopic liver transplantation

PurposeThe current study evaluates the eff cacy of perioperative intravenous use of NAC as apharmaco-protective agent in liver transplant recipients.Methods One hundred patients undergoing living donor liver transplantation (LDLT) were included in this prospective, randomized, double-blind, two parallel groups placebo-controlled trial; Group N (50 patients) received 150mg/kg of IV NAC infusion IV over 15 min before surgery, followed by12.5 mg/kg/h NAC for 4 h after induction of general anesthesia and a subsequent dose of 6.25 mg/kg/h continuous infusion for 3 postoperative days and Group C (50 patients) received equal volume of 0.9% saline IV continuous infusion at the same rate and volume for 3 postoperative days. Both groups will be followed for 14 days after their LT. Primary outcome include postoperative acute kidney injury (POAKI) assessed using RIFLE criteria on admission, day 7 and day 14. Secondary outcomes include severity of the post reperfusion syndrome (PRS) and the incidence of primary graft non-function (PGNF), renal functions test, total dose of loop diuretics and dopamine, adverse events, survival, as well as the length of ICU and hospital stays. Results There was no signifi cant difference (P = 0.8) in the incidence of mild PRS, but the incidence of severe PRS was signifi cantly reduced (P = 0.03) in Group N. RIFLE classifi cation was significantly reduced on admission (P = 0.001), day 7(P = 0.002), and day 14(P = 0.003) respectively in Group N compared to Group C. PGNF was signifi cantly reduced (P = 0.03) in Group N [1 (2%)] than Group C [7(14%)]. During 14 days there was a signifi cant decrease in total dose of loop diuretics, need for dopamine, hospital length of stay, ICU length of stay, renal replacement therapy and the incidence of complications (5 vs. 14 P = 0.02) in Group N than Group C. But there was no significant difference in mechanical ventilator days, and patient survival among groups.Conclusions Perioperative intravenous NAC administration in patients undergoing living donor liver transplantation decreased incidence of postoperative acute kidney injury, severity of PRS and PGNF along with decreased length of ICU and hospital stay with no adverse events , But did not significantly reduce mechanical ventilator days and mortality.