Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 18, 2024; 14(4): 98797
Published online Dec 18, 2024. doi: 10.5500/wjt.v14.i4.98797
Prostaglandin E1 administration post liver transplantation and renal outcomes: A retrospective single center experience
Vinay Jahagirdar, Mohamed Ahmed, Ifrah Fatima, Hassam Ali, Laura Alba, John H Helzberg, Lee S Cummings, Matthew Wilkinson, Jameson Forster, Alisa Likhitsup
Vinay Jahagirdar, Mohamed Ahmed, Ifrah Fatima, Department of Internal Medicine, Saint Luke’s Health System of Kansas City and the University of Missouri-Kansas City, Kansas City, MO 64111, United States
Hassam Ali, Department of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
Laura Alba, John H Helzberg, Division of Internal Medicine, Department of Gastroenterology and Hepatology, Saint Luke’s Health System of Kansas City and University of Missouri-Kansas City, Kansas City, MO 64111, United States
Lee S Cummings, Matthew Wilkinson, Jameson Forster, Department of Surgery, University of Missouri-Kansas City and Transplant Surgery, Saint Luke’s Hospital of Kansas City, Kansas City, MO 64111, United States
Alisa Likhitsup, Department of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI 48109, United States
Author contributions: Jahagirdar V, Ahmed M, and Fatima I were responsible for drafting the manuscript, performing the literature review, data collection, and validation; Alba L, Helzberg J, Cummings L, Wilkinson M, and Forster J contributed to the critical review and editing of the manuscript; Ali H contributed to project administration; Likhitsup A was responsible for study conception, analysis, critical reviewing, and supervision; all authors reviewed the results and approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the institute. Research was conducted in accordance with the ethical standards of the institutional and/or national research committee.
Informed consent statement: Given the retrospective nature of this study, the need for informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hassam Ali, MD, Doctor, Department of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, 2100 Stantonsburg Road, Greenville, NC 27834, United States. alih20@ecu.edu
Received: July 6, 2024
Revised: August 21, 2024
Accepted: September 2, 2024
Published online: December 18, 2024
Processing time: 75 Days and 10.9 Hours
Abstract
BACKGROUND

Prostaglandin E1 (PGE1), or alprostadil, is a potent vasodilator that improves hepatic blood flow and reduces ischemia-reperfusion injury post-liver transplantation (LT). However, the benefits of PGE1 on renal function after LT have not yet been well described.

AIM

To assess the impact of PGE1 administration on renal function in patients who underwent liver or liver-kidney transplant.

METHODS

This retrospective study included all patients who underwent liver or liver-kidney transplant at our institution from January, 2011 to December, 2021. Patients were classified based on whether they received PGE1. PGE1 was administered post-LT to those with transaminases > 1000 U/L in the immediate postoperative period. Demographics, post-LT treatments and/or complications, renal function, and survival were analyzed. Multivariable logistic regression analysis was performed, and a two-tailed P value < 0.05 was considered statistically significant.

RESULTS

A total of 145 patients underwent LT, with 44 (30%) receiving PGE1. Baseline patient characteristics were comparable, except the PGE1 group had significantly higher aspartate aminotransferase (AST) (1961.9 U/L ± 1862.3 U/L vs 878 U/L ± 741.4 U/L, P = 0.000), alanine aminotransferase (1070.6 U/L ± 895 U/L vs 547.7 U/L ± 410 U/L, P = 0.000), international normalized ratio on post-LT day 1 (2 ± 0.74 vs 1.8 ± 0.4, P = 0.03), a longer intensive care unit stay (8.1 days ± 11.8 days vs 3.8 days ± 4.6 days, P = 0.003), more vasopressor use (55.53 hours ± 111 hours vs 16.33 hours ± 26.3 hours, P = 0.002), and higher immediate postoperative complications (18.6% vs 4.9%, P = 0.04). The PGE1 group also had a significantly higher 90-day readmission rate (29.6% vs 13.1%, P = 0.02) and lower 1-year liver graft survival (87.5% vs 98.9%, P = 0.005). However, 30-day readmission (31.6% vs 27.4%, P = 0.64), LT complications (hepatic artery thrombosis, biliary complications, rejection of liver graft, cardiomyopathy), 1-year patient survival (96.9% vs 97.8%, P = 0.77), overall liver graft survival, and overall patient survival were similar between the two groups (95.4% vs 93.9%, P = 0.74 and 88.4% vs 86.9%, P = 0.81 respectively). Although the PGE1 group had a significantly lower glomerular filtration rate (eGFR) on post-LT day 7 (46.3 mL/minute ± 26.7 mL/minute vs 62.5 mL/minute ± 34 mL/minute, P = 0.009), the eventual need for renal replacement therapy (13.6% vs 5.9%, P = 0.09), the number of dialysis sessions (0.91 vs 0.27, P = 0.13), and eGFR at 1-month (37.2 mL/minute ± 35.9 mL/minute vs 42 mL/minute ± 36.9 mL/minute, P = 0.49), 6-months (54.8 mL/minute ± 21.6 mL/minute vs 62 mL/minute ± 21.4 mL/minute, P = 0.09), and 12-months (63.7 mL/minute ± 20.7 mL/minute vs 62.8 mL/minute ± 20.3 mL/minute, P = 0.85) post-LT were similar to those in the non-PGE1 group.

CONCLUSION

In patients who received PGE1 for ischemia-reperfusion injury, despite immediate acute renal injury post-LT, the renal function at 1-month, 6-months, and 12-months post-LT was similar compared to those without ischemia-reperfusion injury. Prospective clinical trials are needed to further elucidate the benefits of PGE1 use in renal function.

Keywords: Liver transplantation; Alprostadil; Protective agents; Transplant; Prostaglandin E1

Core Tip: This retrospective study examines the renal outcomes of prostaglandin E1 (PGE1) administration following liver transplantation (LT). Despite the PGE1 group experiencing initial acute renal injury and higher postoperative complications, their long-term renal function (up to 12 months) was comparable to those not receiving PGE1. The findings suggest that PGE1 may offer renoprotective benefits, warranting further prospective clinical trials to evaluate its potential in mitigating renal dysfunction post-LT.