Prostaglandin E₁ administration following orthotopic liver transplantation: A randomized prospective multicenter trial

Background and Aims: Prostaglandin E₁ (PGE₁) has been used after orthotopic liver transplantation (OLT) based on limited clinical data suggesting PGE₁ infusion improves immediate hepatic allograft function. The aim of this study was to conduct a randomized double-blinded multicenter trial to evaluate the effect of PGE₁ on early hepatic and renal function in patients undergoing OLT. Methods: One hundred eighteen patients were randomized to receive either PGE₁ or crystalloid placebo intravenously after allograft revascularization. Primary end points were incidence of primary allograft nonfunction (PNF) or severe renal dysfunction. Results: The incidence of PNF was 6.7% (4 of 60) and 6.9% (4 of 58) in the control and PGE₁ groups, respectively. PGE₁ infusion was, however, associated with improved early renal function (mean peak creatinine level of 1.4 ± 1.0 and 2.0 ± 1.0 in patients treated with PGE₁ and placebo, respectively; P < 0.001). Severe renal dysfunction occurred more frequently in the placebo group (26.7%) than in the PGE₁ group (13.8%; P = 0.65). Additionally, dialysis treatments were more frequent in the placebo group (0.7 ± 2.0 per patient) than in the PGE₁ group (0.2 ± 1.0 per patient; P = 0.10). Initial intensive care unit stay was shorter in patients treated with PGE₁ (4.0 ± 3.6 days) compared with controls (10.5 ± 17.1 days) (P < 0.01). Conclusions: PGE₁ administration after OLT resulted in improved renal function and decreased initial postoperative intensive care unit stay but did not affect the incidence of PNF.