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Antioxidants for Better Liver Transplant Results

By jeremyc | February 27, 2013

A recent study has shown that administration of NAC (N-acetylcysteine) in liver donors could improve the outcome of the liver transplantation by a significant margin. According to the study, the chances of graft functioning and survival was greater among patients who received their livers from NAC-treated donors than for those patients who received livers from untreated donors. The authors of the study say that this could be helpful for the increasing number of patients who receive less than optimal livers.

The results of the study were published in Liver Transplantation, and it was done on 140 patients who randomly received a graft from donors with either NAC protocol or standard protocol without NAC. In case of the NAC protocol, the donors were administered with a systemic infusion of NAC 30mg/kg for 15 minutes, an hour before the liver harvesting process. They were also administered with a locoregional infusion of NAC 150mg/kg of liver weight immediately before the cross clamping.

In the NAC group, the survival rates of the grafts were 93, 90, and 86 percent after 3, 12, and 24 months respectively. On the other hand, the rates were 82, 70, and 67 percent for the non-NAC group. During the medium follow-up after 33.4 months, the number of patients who died in the non-NAC group was double that of the patients who died in the NAC group.

One of the biggest determinants of graft survival is ischemia/reperfusion injury, which is the result of oxidative stress and cytotoxicity. NAC could be helpful to the liver in replenishing its antioxidant GSH levels, according to Fransesco D’Amico and other colleagues from the University Hospital of Padua, Italy, the authors of the study. They concluded, “This harvesting procedure should be used in the context of a multimodal strategy aimed at improving the outcomes of [liver transplantation], increasing the use of suboptimal livers, and extending and standardizing the use of such relevant resources.”

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