REDUCTION OF REPERFUSION INJURY WITH PROSTACYCLIN 12 AFTER LIVER TRANSPLANTATION

Abstract

209 Organ shortage of suitable liver grafts is responsible for the use of marginal donors for liver transplantation (OLT). If these liver grafts develop an initial poor function after liver transplantaton a supportive therapy is necessary to improve the liver function. Experimental data have shown that prostacyclin I2 (PGI2) has cytoprotective effects for hepatocytes. The purpose of this study was to evaluate the effects of PGI2 on postoperative liver graft function after OLT. In this prospective randomized trial we studied the effects of PGI2 on postoperative liver graft function, hemodynamics and tumour necrosis factor release in patients after OLT. With institutional approval and informed consent, 30 adult patients (10 female), receiving liver grafting were enrolled in this study. Patients were randomised to either receive PGI2 (n=15) or placebo. PGI2 was administered at a rate of 4 ng/kg/min body weight after reperfusion for 6 days. To evaluate regional splanchnic oxygenation a fiberoptic pulmonary artery catheter was inserted into the right hepatic vein and the difference(ΔSO2) of mixed venous saturation (SvO2) and hepatic venous oxygen saturation (SvhO2) was calculated. Measurements were performed directly after transplantation and 6-, 12-, 24- and 48- hours postoperatively. Levels of TNF were determined once daily for the time period of PGI2 treatment. Statistical analysis was performed using Wilcoxon Rank- Sum- test and Pearson correlation, significance was accepted at p<0.05. A significant correlation for ΔSO2 and the level of transaminasis was observed 24 and 48 hours after transplantation (p<0.05). PGI2 treatment induced a significant decrease in ΔSO2 after 12 and 24 hours after reperfusion (p<0.05). Hemodynamics were not changed in either group. Peak levels of ASAT were in tendency lower in the PGI2 treatment group (418±99 vs. 638±156 U/l). TNF levels were not altered in patients receiving placebo treatment. Several experimental data suggest a cytoprotective effect of PGI2 for hepatocytes. We conclude that introduction of PGI2 after OLT improves hepatic-splanchnic oxygenation. This effect might be attributed for reduction of reperfusion injury after OLT.