gms | German Medical Science

Introduction: Ischemia/reperfusion injury (IR) after liver transplantation (LT) may be associated with primary dysfunction or nonfunction of the graft. Prostacyclines were demon-strated to be beneficial in reducing IR by improving liver perfusion and by protecting endothelial cells in vitro. The aim of this clinical trial was to analyze the impact of a systemically administered prostacyclin analogue on allograft viability after LT.

Materials and methods: We initiated a prospective randomized placebo controlled single center study. All pa-tients included were treated with a comparable calcineurin-inhibitor based quadruple induction immunosuppressive regimen posttransplant. Patients of the treatment group received Iloprost (Ilomedin®, Schering GmbH, Berlin; 1ng/kgKG/min), systemi-cally administered for 7 days post-LT, in contrast to the control population. Peak lev-els of transaminases (ASAT/ALAT), factor V, quick’s value, bile production and the ICG-PDR, were determined continuously. Furthermore, the arterial resistive index (RI) as parameter of liver perfusion as well as patient and graft survival were evalu-ated. The differences between both cohorts were calculated using a Mann-Wilcoxon U-Test, a p-value below 0,05 was considered to be significant.

Results: Results of the first 35 (18/17) patients included are presented. In the treatment group we noticed a significant improvement of allograft synthetical capabilities on POD 1 (factor V: Iloprost: 57,3% ± 5,7; control: 35,9% ± 3,5; p=0,011) and POD 3 (quick’s value: Iloprost: 78,5% ± 4,7; control: 64,0% ± 5,0; p=0,03). In addition, bile production was higher under Iloprost (POD 1: p=0,016). The arterial RI decreased in the treat-ment population significantly on POD 2 (p=0,008). Transaminases and ICG-PDR val-ues were comparable between both cohorts. The 30-day-patient-survival was 100% in the treatment group, and 94% in the control population (ns). There were 5 cases of early graft failure, 4 in the control group (24%), and one in the treatment population (6%). Three of them (control group) un-derwent retransplantation, two recipients recovered completely under Iloprost. One of them (control group) was switched into the treatment group. There were no signifi-cant drug-induced adverse effects.

Conclusion: Our first results of an ongoing study are very encouraging. We assume Iloprost to be beneficial in ameliorating early posttransplant liver function. If the rate of primary and delayed allograft dysfunction will be reduced with this treatment concept has to be analyzed with a higher number of patients included in the future.