Effect of treatment with prostaglandin E-1 and N-acetylcysteine on pediatric liver transplant recipients: A single-center study

Prostaglandin E-1 (PGE(1)) and N-acetylcysteine (NAC) have been used as sin gle agents to decrease reperfusion injury and improve outcome after solid-o rgan transplantation (Tx). We hypothesized that combined treatment with NAC and PGE(1) would be safe and reduce reperfusion injury. We therefore carri ed out a pilot study to assess the safety of this drug combination and gain information regarding the efficacy of treating pediatric liver transplant recipients with NAC and PGE(1). The pilot study took the form of an open-la bel study incorporating 25 pediatric liver transplant recipients(12 childre n in the treatment group and 13 children as controls). NAC (70 mg/kg) was g iven intravenously over 1 h following reperfusion and then every 12 h for 6 days. PGE(1) (0.4 mg/kg/h) was given as a continuous intravenous infusion for 6 days. starting after the first NAC dose. The primary outcome was the safety of combined treatment with NAC and PGE(1). Patient survival. graft s urvival, allograft rejection within the first 90 days after Tx, peak post-t ransplant serum alanine aminotransferase (ALT) concentration, post-transpla nt length of hospitalization, and postoperative complications were secondar y outcomes. Post-operative complications: occured at similar rates in both control and treated groups. No complications or adverse events occured in t he treated group as a result of study drugs. The 3-month patient survival r ate was 100% for both groups. For the group treated with NAC and PGE(1), pe ak serum ALT was lower and median length of stay was shorter but the differ ences did not reach statistical significance. The proportion of patients wi th allograft rejection was not significantly different between the two grou ps. However, rejection was more severe in the control group than in the tre ated group. In summary, infusions of NAC and PGE(1) were safely administere d to pediatric liver transplant recipients. However, a randomized controlle d study is needed to determine the efficacy of treatment with NAC and PGE(1 ).