A DOUBLE-BLIND, RANDOMIZED PLACEBO-CONTROLLED TRIAL OF PROSTAGLANDIN E(1) IN LIVER-TRANSPLANTATION

A double-blind placebo-controlled trial of intravenous prostaglandin P GE(1) (40 mu g/h) was conducted in adult orthotopic liver transplant r ecipients. Infusion was started intraoperatively and continued for up to 21 days. Patients were followed up for 180 days postoperatively. Am ong 172 patients eligible for treatment in the study, 160 could be eva luated (78 PGE(1); 82 placebo), Patient and graft survival were simila r (PGE(1): 16 deaths, 9 retransplantations [7 survivors]; controls: 15 deaths, 6 retransplantations [3 survivors]). In patients with survivi ng grafts, however, PGE(1) administration resulted in a 23% shorter me an duration of hospitalization following transplantation (PGE(1): 24.4 days; controls: 31.8 days; P = .02) and a 40% shorter length of time postoperatively in the intensive care unit (PGE(1): 8.2 days; controls 13.7 days; P = .05), Reduced needs for renal support (P = .03) or sur gical intervention other than retransplantation (P = .02) were also no ted with PGE(1) use. Further, PGE(1) administration resulted in a tren d toward improved survival rates in patients with mild renal impairmen t (preoperative serum creatinine 1.5 mg percent or greater; P = .08), Neither the incidence of acute cellular rejection nor of primary nonfu nction was significantly different in the two groups. Phlebitis was th e only complication that was more common during PGE(1) administration, (PGE(1): 9; controls: 4), These results suggest that PGE(1) in hepati c allograft recipients reduces morbidity and may result in sizable cos t reductions.