Khalili F, Khosravi M B, Sahmeddini M A, Eghbal M H, Kazemi K, Nikeghbalian S, Ghazanfar Tehran S, Khosravi B
Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Shiraz Organ Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Int J Organ Transplant Med. 2021;12(1):12-20.
Ischemia-reperfusion injury during transplantation can cause post-operative graft dysfunction.
To assess the efficacy of N-acetylcysteine in preventing hepatic ischemia-reperfusion injury and post-transplant outcomes.
In this retrospective study on pediatrics undergoing living-donor (from one of their parents) liver transplantation, N-acetylcysteine was administered to one group (n=20) after induction in the donors until graft harvest, and in the recipients during implantation, which was maintained for 19 hours. The second group (n=20) did not receive NAC. Early allograft dysfunction was determined in the presence of alanine aminotransferase or aspartate aminotransferase ≥2000 IU/L and bilirubin ≥10 mg/dL within the first 7 days, and an international normalized ratio ≥1.6 on day 7. Data were collected from a retrospectively maintained database.
The incidence of post-reperfusion syndrome was lower in N-acetylcysteine group compared with the other group (5% . 30%, p=0.037). Serum creatinine level was significantly (p=0.04) different in the N-acetylcysteine group during the second post-operative week (0.14 . 0.15 mg/dL). There was no significant difference in the incidence of early allograft dysfunction (21% . 14%, p=0.327), and the survival rate (p=0.409).
Peri-operative infusion of N-acetylcysteine in both donor and recipient would effectively prevent post-reperfusion syndrome and renal insufficiency. However, it might not affect the early allograft dysfunction, ICU stay, and mortality. NAC increases the chance of re-operation due to non-surgical bleeding in the first post-operative day.
移植过程中的缺血再灌注损伤可导致术后移植物功能障碍。
评估N-乙酰半胱氨酸预防肝缺血再灌注损伤及移植后结局的疗效。
在这项对接受活体（来自其父母一方）肝移植的儿科患者的回顾性研究中，一组（n = 20）供体在诱导后直至获取移植物期间给予N-乙酰半胱氨酸，并在受体植入期间给予，持续19小时。第二组（n = 20）未接受NAC。早期移植物功能障碍的判定标准为在术后第1个7天内丙氨酸转氨酶或天冬氨酸转氨酶≥2000 IU/L且胆红素≥10 mg/dL，以及在第7天国际标准化比值≥1.6。数据从回顾性维护的数据库中收集。
与另一组相比，N-乙酰半胱氨酸组再灌注综合征的发生率较低（5% 对30%，p = 0.037）。术后第二周N-乙酰半胱氨酸组血清肌酐水平有显著差异（p = 0.04）（0.14对0.15 mg/dL）。早期移植物功能障碍的发生率（21% 对14%，p = 0.327）和生存率（p = 0.409）无显著差异。
供体和受体围手术期输注N-乙酰半胱氨酸可有效预防再灌注综合征和肾功能不全。然而，它可能不影响早期移植物功能障碍、重症监护病房停留时间和死亡率。NAC增加了术后第一天因非手术出血而再次手术的几率。
