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Tacrolimus as a liver flush solution to ameliorate the effects of ischemia/reperfusion injury following liver transplantation
Author(s) -
St. Peter Shawn D.,
Post David J.,
RodriguezDavalos Manuel I.,
Douglas David D.,
Moss Adyr A.,
Mulligan David C.
Publication year - 2003
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2003.50018
Subject(s) - medicine , liver transplantation , tacrolimus , placebo , liver function , transplantation , reperfusion injury , liver injury , randomized controlled trial , ischemia , liver function tests , prospective cohort study , gastroenterology , anesthesia , surgery , urology , pathology , alternative medicine
The goal of this report is to evaluate in a prospective randomized fashion the effect of flushing hepatic allografts with tacrolimus before transplantation. A prospective, double‐blinded, randomized trial was performed. Twenty patients receiving orthotopic liver transplants from October 2000 to October 2001 were randomized into two groups. Group 1 (active) was administered tacrolimus, 20 ng/mL, plus Plasma‐lyte A (Baxter Healthcare Corp, Deerfield, IL) liver flush solution; and group 2 (placebo) was administered only Plasma‐lyte A. Ischemia/reperfusion injury was assessed in both groups after transplantation by means of serum laboratory values to assess hepatocellular damage, synthetic function, and ion transport capacity. Peak values were recorded for each parameter, and their distributions were compared. There were no statistically significant differences between groups for age, sex, total ischemia time, or cause of liver disease. Global multivariate comparison of peak changes in all measures of liver function indicated liver injury was significantly lower with tacrolimus treatment than placebo ( P = .01). The sample median for group 1 was less than for group 2 in all parameters measured. Individual statistical comparison showed that peak changes from baseline aspartate aminotransferase and activated partial thromboplastin time values were significantly improved ( P ≤ .05) with tacrolimus treatment than placebo treatment. In this prospective, double‐blinded, randomized trial, we show that flushing the liver before transplantation with Plasma‐lyte A containing tacrolimus results in superior early graft function and decreased hepatocellular injury after reperfusion compared with flushing with Plasma‐lyte A alone.