Use of N-Acetylcysteine in Fatty Liver Donors.

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Introduction Fatty infiltration of the liver is increasing in the US population as obesity in our population multiply. This finding is associated with dysfunction or PNF of transplanted livers, and biopsy findings are the primary reason for liver discard, most of which are due to the presence of hepatic steatosis. The mechanism of injury to the liver graft is thought to arise secondary to free radical release on reperfusion of the liver. N-acetylcysteine (NAC) is used routinely in hepatic failure as a means to replenish glutathione stores and surgeons are using NAC in extended criteria recipients to maximize hepatocyte preservation. We conducted a pilot study to evaluate if intraoperative NAC administration would affect the early graft function of steatotic donor allografts. Methods We reviewed data from patients undergoing liver transplants at our center comparing patients receiving a liver graft with 10%-25% macrosteatosis and given NAC versus those with a comparable degree of steatosis and not receiving NAC. Outcome measures were determined to be the changes in hepatic function parameters from the immediate pre-transplant values in the donor and the respective peak values in the early postoperative period as well as common outcome variables. Results During the period 07/ 2012 to 09/2013, 15 donors had at least 10% macrosteatosis, of who 9 received NAC. There were 5/9 and 2/6 males, p=0.61, in the NAC and non-NAC groups respectively, and there was no difference in ages/years, mean 59 ± 10, versus 60 ± 8, p=0.84. The cold ischemia time/min in the respective groups was, median 344 (range 196-507) versus 407 (range 269-527), p=0.32, and the warm ischemia time was, median 44 (34-52), versus 40 (29-54), p=1.00. The change in AST (U/L) was median 789 (509-8530) in the NAC group and 681 (402-1930) in the non-NAC group, p=0.175. Similarly ALT (U/L) changes in the two groups were 522 (248- 2948) to 365 (180-1189), respectively, p=0.366. The peak post-operative lactate (mmol/L) level was 1.7(1.2-4.5) to 1.9(0.8-4.7), p=0.83. Average hospital length of stay in two groups was 10.75 days compared to 12.83 days (p=0.571). Significant complication rate was 2/9 on NAC vs. 1/5in non-NAC. PEGF 1/9 in NAC group and 0/6 in non-NAC group, 3 month survival was 100% in both groups Discussion Our data failed to show benefit of NAC as hepatoprotective agent for steatotic livers. However prospective randomized studies are needed to further evaluate this effect.

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