N-acetylcysteine in the Donor, Recipient, or Both Donor and Recipient in Liver Transplantation: A Systematic Review With Meta-analysis and Trial Sequential Analysis

Abstract

Background. N-acetylcysteine (NAC) is a potentially effective drug for treating ischemia–reperfusion injury in transplanted livers, but its effect remains controversial. Methods. A systematic review and meta-analysis of relevant clinical trials published and registered in the Cochrane Library, MEDLINE, EMBASE, ClinicalTrial.gov, WHO ICTRP, etc, before March 20, 2022 were conducted and registered with PROSPERO (CRD42022315996). Data were pooled using a random effects model or a fixed effects model based on the amount of heterogeneity. Results. Thirteen studies with 1121 participants, 550 of whom received NAC, were included. Compared with the control, NAC significantly reduced the incidence of primary graft nonfunction (relative risk [RR], 0.27; 95% confidence interval [CI], 0.08-0.96), the incidence of postoperative complications (RR, 0.52; 95% CI, 0.41-0.67), the peak postoperative aspartate transferase level (mean difference [MD], −267.52; 95% CI, −345.35 to −189.68), and the peak alanine transferase level (MD, −293.29; 95% CI, −370.39 to −216.20). NAC also improved 2-y (RR, 1.18; 95% CI, 1.01-1.38) graft survival rate. However, NAC increased the intraoperative cryoprecipitate (MD, 0.94; 95% CI, 0.42-1.46) and red blood cell (MD, 0.67; 95% CI, 0.15-1.19) requirements. Moreover, NAC was administered in various modes in these studies, including to the donor, recipient, or both. Subgroup analysis and network meta-analysis showed that NAC administration to recipients could play a more significant role than the other 2 administration modes. Conclusions. Our study supports the protective effect of NAC against LT-induced ischemia–reperfusion injury and shows better clinical outcomes of NAC administration to recipients.

Effect of dexmedetomidine on liver transplantation: a meta-analysis

“…Heterogeneity was considered when P Heterogeneity< 0.1 or I2 >50%. When statistical heterogeneity existed among the studies, the random effect model was used to summarize the data; otherwise, the fixed effect model was used ( Jia et al, 2023 ). At the same time, we plan to use subgroup analysis to find the influencing factors of DEX efficacy.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2023

“…The following 3 articles 11,12,48 concerning the prevention of postreperfusion syndrome (PRS), a relatively common and potentially life-threatening complication during LT, were published in 2023.…”

“…While the efficacy of N-acetylcysteine (NAC) in LD LT has not been established, several authors reported the effect of NAC in treating patients with nonacetaminophen-induced acute liver failure undergoing LT. Jia et al performed a systematic review with meta-analysis concerning the effect of NAC for treating IRI in transplanted livers. 11 Thirteen studies with 1121 participants, 550 of whom received NAC, were included. Compared with the control group, NAC significantly reduced the incidence of primary graft dysfunction [relative risk (RR), .27; 95% CI, .08-.96], the incidence of postoperative complications (RR, .52; 95% CI, .41-.67), the peak postoperative AST level [mean difference (MD); À267.5; 95% CI, À345.4 to À189.7], and the peak alanine aminotransferase (ALT) level (MD, À293.29; 95% CI, À370.39 to À216.20).…”

N-acetylcysteine and Reduction of Ischemia-reperfusion Injury in Liver Transplantation

“…I n the current issue of Transplantation, Jia et al perform a systemic review and meta-analysis looking at the utilization of N-acetylcysteine (NAC) in the donor and recipient in liver transplantation. 1,2 It has been suggested that NAC may have a role in mitigating ischemia-reperfusion injury that occurs during the various stages of organ donation. The pathophysiology of ischemia-reperfusion injury is mainly due to the oxidative stress and cytotoxicity arising from the imbalance between oxidants and antioxidants.…”