Prophylactic administration of prostaglandin E1 in liver transplantation: Results of a pilot trial

ORTHOTOPIC LIVER transplantation (OLT) has now achieved a 1-year survival of 80% to 90%. Most deaths occur within 3 months after OLT, primary graft dysfunction (PGD), or infection (these are the most common causes). PGD can be categorized as primary nonfunction (PNF) or initial poor function. PNF has a poor prognosis, with a near 100% mortality rate without retransplantation. In cases of retransplantation, morbidity and mortality rates are much higher than in primary grafts. Ischemia reperfusion injury can be considered one of the most important causative determinants in PGD. 1,2 Reperfusion injury is associated with the re-establishment of the blood flow and oxygen to a previously anoxic organ, leading to the production of oxygen-derived free radicals (ODFRs), cytokines, and other cytotoxic products such as tromboxanes and leukotrienes, which can activate and damage endothelial cells, leading to parenchymal damage and eventually to graft failure. 3–5 The beneficial effect of prostaglandin E 1 (PGE 1 ) administration for the prevention of liver reperfusion injury and primary graft dysfunction has been observed in animal experimental models, 6–9 in clinical studies, 10–13 and has been confirmed in a recent clinical trial in which it was administered during 21 days. 14 To show the beneficial effect of prophylactic administration of PGE 1 during a shorter period, we conducted a trial of prophylactic use of PGE 1 immediately after reperfusion of the grafted liver. Follow-up after OLT in 21 consecutive patients receiving PGE 1 was compared with a group of OLT patients previously transplanted who did not receive PGE 1 .