N-Acetylcysteine and Liver Transplant. Advantages of its Administration in Multi-Organ Donors Especially During World-Economical-Crisis. Long-Term Sub-Group Analysis in a Randomized Study

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-01-14 DOI:10.1016/j.transproceed.2024.11.038

Michele Finotti , Alberto Zanetto , Alessandro Vitale , Manuel Rodriguez-Davalos , Patrizia Burra , Umberto Cillo , Francesco D'Amico

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引用次数: 0

Abstract

Background

Liver transplantation (LT) is the main indication for the treatment of end-stage liver disease but have to face organ shortages. Using marginal donors is an option to increase the donor pool. Previous studies showed that the graft procured using N-acetylcysteine (NAC) provides a longer survival compared to perfusion with standard solutions, especially in marginal liver donors. We now evaluate the effect of NAC perfusion compared to control (no NAC protocol) at a 5-year follow-up, with a special focus on the overall survival (OS) and graft survival.

Methods

Single-center, retrospective review of the OS and graft survival among NAC and control group, with a sub-stratification based on the LT indication.

Results

140 donors were enrolled: 69 in the NAC protocol and 71 in the control group. The 5-year OS was 84% in the NAC protocol compared to 63% in the control (P = .0045). In LT for HCC, the OS at 5 years was 80% and 55% in the study group and control group, respectively (P = .04), with no statistical difference in the RFS (P = .46). Furthermore, in cost analysis, the resources needed for the NAC protocol is negligible compared to the control group. Beneficial tendency of NAC protocol application has been seen in the other organs (lungs, hearts, pancreas, kidney and intestine)

Conclusion

The application of NAC infusion in liver donors improves the overall survival of the recipient, especially in the HCC and HCV LT indications.

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n -乙酰半胱氨酸与肝移植。多器官供体管理的优势，特别是在世界经济危机时期。随机研究的长期亚组分析。

背景：肝移植是治疗终末期肝病的主要指征，但面临器官短缺的问题。使用边际捐助者是增加捐助者池的一种选择。先前的研究表明，与标准溶液灌注相比，使用n -乙酰半胱氨酸（NAC）获得的移植物可提供更长的存活时间，特别是在边缘肝供者中。我们现在在5年随访中评估NAC灌注与对照组（无NAC方案）的效果，特别关注总生存期（OS）和移植物生存期。方法：单中心回顾性评价NAC组和对照组的OS和移植物存活率，并根据肝移植适应症进行亚分层。结果：共入组140例：NAC方案69例，对照组71例。NAC方案的5年OS为84%，而对照组为63% （P = 0.0045）。肝癌肝移植治疗中，研究组5年OS为80%，对照组5年OS为55% (P = 0.04)， RFS无统计学差异（P = 0.46）。此外，在成本分析中，与对照组相比，NAC协议所需的资源可以忽略不计。在其他器官（肺、心、胰、肾、肠）应用NAC方案也有有益的趋势。结论：在肝供者中应用NAC输注可提高受者的总生存率，特别是在HCC和HCV肝移植适应症中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.