Antioxidant improves donated liver survival rate to more than 90 percent

February 25, 2013, Wiley

Researchers from Italy have found that the antioxidant, N-acetylcysteine (NAC), when injected prior to harvesting of the liver, significantly improves graft survival following transplantation. Results published in the February issue of Liver Transplantation, a journal of the American Association for the Study of Liver Diseases (AASLD), suggest that the NAC effect on early graft function and survival is higher when suboptimal organs are used.

A 2010 (WHO) report estimates that 22,000 were performed worldwide, with nearly 18,500 from deceased donors. According to the Organ Procurement and Transplantation Network (OPTN) close to 16,000 U.S. patients are currently on the waiting list for a liver. Nearly 18,500 deceased donor transplants were performed between January and October 2012 in the U.S. OPTN reports that roughly 7,000 livers were recovered from deceased donors during the same time period.

"Liver transplantation is the standard treatment for end-stage ," explains lead author Dr. Francesco D'Amico from Padova University in Italy. "Antioxidants such as NAC could potentially reduce damage to deceased , improving graft function." Studies have shown that ischemia-reperfusion injury (IFI)—damage to the when blood supply returns to the liver after (ischemia)—often occurs during storage and preservation of donated livers, and impacts early post-transplantation.

For the present study researchers assigned 140 organs to adult candidates with liver disease undergoing their first transplant. An NAC infusion of 30 mg/kg was administered to one hour prior to liver procurement and another infusion of 300 mg (150mg/kg liver weight) through the portal vein before cross-clamping. There were 69 who received an NAC infused organ and 71 patients who had a standard transplant without NAC.

Results indicate that graft survival rates at 3 and 12 months were 93% and 90%, respectively, for patients receiving NAC infused livers; rates were 82% and 70% in the control group. Post-transplant complication rates were 23% for the NAC group and 51% in the control group. Analysis of the 61 patients receiving suboptimal livers the incidence of organ dysfunction was lower in the NAC group compared to controls at 15% and 32%, respectively.

Dr. D'Amico concludes, "Our study was the first randomized trial to investigate the use of NAC antioxidant infusion during the liver procurement procedure. We propose that NAC be used during organ harvesting to improve liver transplantation outcomes, particularly with the increased use of suboptimal organs. NAC has a good safety profile and the very low cost per patient, make this protocol highly cost-effective in consideration of grafts survival, length of hospital stays and post operative complications. Moreover we are performing further analyses to determine beneficial effects on the other organ procured with NAC protocol."

In a related editorial published this month in the authors from the University of California, San Francisco (UCSF) and OneLegacy (Organ Procurement Organization, Los Angeles) highlight the importance and rarity of deceased organ donor research, such as the study by D'Amico et al., despite the fact that randomized clinical trials are essential to evidence-based medicine. Dr. Claus Niemann from the Department of Anesthesia and the Department of Surgery, Division of Transplantation at UCSF said, "Well-controlled deceased donor research is crucial to uncovering superior clinical practices that improve organ utilization and transplant outcomes. However, researchers are currently operating in a regulatory and legal vacuum since no review and oversight policies are established."

Explore further: Most liver transplant candidates receive donation offers

More information: "Use of N-Acetylcysteine During Liver Procurement: A Prospective Randomized Controlled Study." Francesco D'Amico, Alessandro Vitale, Anna Chiara Frigo, Donatella Piovan, Alessandra Bertacco, Domenico Bassi, Rafael Ramirez Morales, Pasquale Bonsignore, Enrico Gringeri, Michele Valmasoni, Greta Garbo, Enrico Lodo, Francesco Enrico D'Amico, Michele Scopelliti, Amedeo Carraro, Martina Gambato, Alberto Brolese, Giacomo Zanus, Daniele Neri and Prof. Umberto Cillo. Liver Transplantation; (DOI: 10.1002/lt.23527) Print Issue Date: February, 2013.

Editorial: "Deceased Organ Donor Research: The Last Research Frontier?" Thomas Mone, John Heldens and Claus U. Niemann. Liver Transplantation; (DOI: 10.1002/lt.23579) Print Issue Date: February, 2013.

Related Stories

Most liver transplant candidates receive donation offers

October 22, 2012
Most liver transplant candidates who died or were removed from the transplant list actually received one or more liver donation offers, according to a recent UCSF study.

Transplant candidates seek 'best quality' livers despite having to remain on waiting list

December 1, 2011
New research reveals that liver transplantation candidates want to be involved in decisions regarding quality of the donor organ, and many are reluctant to accept organs with a higher risk of failure. In fact, more than 42% ...

Obese donors increase risk of death for pediatric liver transplant recipients

August 1, 2012
Children undergoing liver transplantation are at greater risk of graft loss and death from adult organ donors who are severely obese according to research published in the August issue of Liver Transplantation, a journal ...

Decline in available liver transplants expected

January 10, 2013
A new study, funded in part by the National Institutes of Health (NIH) and Health Resources and Services Administration, and published in the January 2013 issue of Liver Transplantation, a journal of the American Association ...

High-risk donor livers used with greater frequency in transplantations

September 28, 2011
The shortage of available organs for transplantation has driven up use of high-risk donor livers. New research published in the October issue of Liver Transplantation, a journal of the American Association for the Study of ...

Living donor liver transplantation improves survival over deceased donor transplants

September 27, 2011
New research shows liver transplantation candidates without hepatocellular carcinoma (HCC) derive a greater survival benefit from a living donor liver transplant (LDLT) than waiting for a deceased donor liver transplant (DDLT). ...

Recommended for you

Tongue-in-cheek Nobels honor nutritional analysis of cannibalism, roller-coaster kidney stones treatment

September 14, 2018
A nutritional analysis of cannibalism and treating kidney stones on roller-coasters were research projects honored by tongue-in-cheek awards at Harvard University Thursday, designed to make you laugh first, and think later.

Pediatric robot patient offers new level of realism for doctors in training

September 10, 2018
A team of researchers and engineers at Gaumard Scientific has unveiled a new robot that raises the bar on medical training devices. The robot, called HAL, has been made to look like a five-year-old male patient and offers ...

Why men say they've had more lifetime sexual partners than women

July 25, 2018
The disparity between the number of sexual partners reported by men and women can largely be explained by a tendency among men to report extreme numbers of partners, and to estimate rather than count their lifetime total, ...

Censors jump into action as China's latest vaccine scandal ignites

July 22, 2018
Chinese censors on Sunday deleted articles and postings about the vaccine industry as an online outcry over the country's latest vaccine scandal intensified.

Revenge of a forgotten medical 'genius'

June 30, 2018
It's not an uncommon fate for a pioneering scientist: languishing unrecognised in his time before dying in obscurity. But as his 200th birthday approaches, the life-saving work of a Hungarian obstetrician is finally getting ...

Yes, you can put too much chlorine in a pool

June 2, 2018
(HealthDay)—Before you take a dip in the pool this summer, be sure there's not too much chlorine in the water.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.