Administration of prostacyclin after liver transplantation:: a placebo controlled randomized trial

The shortage of suitable organs for liver grafts is responsible for the use of marginal donors for liver transplantation (OLT). If these liver grafts function poorly initially after OLT, a supportive therapy is necessary. The purpose of this study was to evaluate the effects of prostacyclin (PGI(2)) on postoperative liver graft function after OLT. A total of 30 adult recipients of primary OLT were randomized to either receive PGI(2) (4 ng/kg per min body weight, n = 15) or a placebo for 6 d. To evaluate regional splanchnic oxygenation a fiberoptic pulmonary-artery catheter was inserted into a hepatic vein and the difference between mixed venous oxygen content and hepatic venous oxygen content was determined (Delta O-2). Measurements were performed directly after transplantation and at 6, 12, 24 and 48 h postoperatively. A significant correlation between Delta O-2 and the level of transaminases (ALT/AST) was observed 24 and 48 h after transplantation (p < 0.05). PGI(2) treatment induced a significant decrease in Delta O-2 after 24 and 48 h after reperfusion (p < 0.05). Peak AST levels tended to be lower in the PGI(2) treatment group (418 +/- 99 vs. 638 +/- 156 U/L, p < 0.1). These results suggest that administration of PGI(2) after OLT improves hepatic-splanchnic oxygenation and may thereby reduce reperfusion injury after OLT.