Prostaglandin E1 Administration Post Liver Transplantation and Renal Outcomes: A Retrospective Single Center Experience

Overview

Journal World J Transplant

Publisher Baishideng Publishing Group

Specialty General Surgery

Date 2024 Dec 19

PMID 39697460

Authors

Vinay Jahagirdar

Mohamed Ahmed

Ifrah Fatima

Hassam Ali

Laura Alba

John H Helzberg

Lee S Cummings

Matthew Wilkinson

Jameson Forster

Alisa Likhitsup

Affiliations

Soon will be listed here.

Abstract

Background: Prostaglandin E1 (PGE1), or alprostadil, is a potent vasodilator that improves hepatic blood flow and reduces ischemia-reperfusion injury post-liver transplantation (LT). However, the benefits of PGE1 on renal function after LT have not yet been well described.

Aim: To assess the impact of PGE1 administration on renal function in patients who underwent liver or liver-kidney transplant.

Methods: This retrospective study included all patients who underwent liver or liver-kidney transplant at our institution from January, 2011 to December, 2021. Patients were classified based on whether they received PGE1. PGE1 was administered post-LT to those with transaminases > 1000 U/L in the immediate postoperative period. Demographics, post-LT treatments and/or complications, renal function, and survival were analyzed. Multivariable logistic regression analysis was performed, and a two-tailed value < 0.05 was considered statistically significant.

Results: A total of 145 patients underwent LT, with 44 (30%) receiving PGE1. Baseline patient characteristics were comparable, except the PGE1 group had significantly higher aspartate aminotransferase (AST) (1961.9 U/L ± 1862.3 U/L 878 U/L ± 741.4 U/L, = 0.000), alanine aminotransferase (1070.6 U/L ± 895 U/L 547.7 U/L ± 410 U/L, = 0.000), international normalized ratio on post-LT day 1 (2 ± 0.74 1.8 ± 0.4, = 0.03), a longer intensive care unit stay (8.1 days ± 11.8 days 3.8 days ± 4.6 days, = 0.003), more vasopressor use (55.53 hours ± 111 hours 16.33 hours ± 26.3 hours, = 0.002), and higher immediate postoperative complications (18.6% 4.9%, = 0.04). The PGE1 group also had a significantly higher 90-day readmission rate (29.6% 13.1%, = 0.02) and lower 1-year liver graft survival (87.5% 98.9%, = 0.005). However, 30-day readmission (31.6% 27.4%, = 0.64), LT complications (hepatic artery thrombosis, biliary complications, rejection of liver graft, cardiomyopathy), 1-year patient survival (96.9% 97.8%, = 0.77), overall liver graft survival, and overall patient survival were similar between the two groups (95.4% 93.9%, = 0.74 and 88.4% 86.9%, = 0.81 respectively). Although the PGE1 group had a significantly lower glomerular filtration rate (eGFR) on post-LT day 7 (46.3 mL/minute ± 26.7 mL/minute 62.5 mL/minute ± 34 mL/minute, = 0.009), the eventual need for renal replacement therapy (13.6% 5.9%, = 0.09), the number of dialysis sessions (0.91 0.27, = 0.13), and eGFR at 1-month (37.2 mL/minute ± 35.9 mL/minute 42 mL/minute ± 36.9 mL/minute, = 0.49), 6-months (54.8 mL/minute ± 21.6 mL/minute 62 mL/minute ± 21.4 mL/minute, = 0.09), and 12-months (63.7 mL/minute ± 20.7 mL/minute 62.8 mL/minute ± 20.3 mL/minute, = 0.85) post-LT were similar to those in the non-PGE1 group.

Conclusion: In patients who received PGE1 for ischemia-reperfusion injury, despite immediate acute renal injury post-LT, the renal function at 1-month, 6-months, and 12-months post-LT was similar compared to those without ischemia-reperfusion injury. Prospective clinical trials are needed to further elucidate the benefits of PGE1 use in renal function.

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