α-Lipoc Acid Improve the Short Term Outcomes in Human Liver Transplantation.

CASCIATO, P; AMBROSI, N; CARO, F; VASQUEZ, M. M. ,1 ; GADANO, A; DE SANTIBAÑES, M; E. DE SANTIBAÑES; ZANDOMENI, M.; CHAHDI, M.; LAQUINANDI, J; SANTOFIMIA CASTAÑO, P.; IOVANNA, J.; CHULUYAN, E.; INCARDONA, C.

Chicago

Congreso; American Transplant Congress; 2017

In liver transplantation (LT) the postreperfusion syndrome (PRS) is a serious intraoperative complication. The effect of α-lipoic acid (ALA) has not been evaluated. A double blind randomized controlled trial was performed to compare the safety and efficacy of α-lipoic acid versus placebo. The graft was randomized to receive 600 mg of ALA or placebo before the cold ischemia time. Furthermore, patients transplanted with ALA perfused graft received 600mg of intravenous ALA (group ALA+), while patients received non perfused graft received placebo (group ALA-) just before graft reperfusion. 23 patients (ALA+ n=13 and ALA- n=10) were included. The mean MELD was 24 in both groups. Blood samples and hepatic biopsy were obtained 2 hours post reperfusion. Real-time PCR analysis was performed on biopsies for birc2, sestrin2, IKba, Hifa, IL-8, IL-6, phd1, phd2 and alarmins reg3a and SLPI. The follow up was 30 days. The incidence of PRS and postoperative course were compared. There were no adverse events due to AAL infusion. 6/23 patients developed PRS, five of these belonged to ALA negative group.There were not differences on birc2, sestrin2, IKba, hifa, IL-6 e IL-8. There was a decrease in reg3a (gene involved in cell proliferation and liver carcinogenesis), phd1 and phd2 (molecular oxygen sensors involved in liver regeneration) and an increase in SLPI (gene that protects tissues from serine proteases) transcripts in the biopsies from ALA+ compared with ALA- group. However, in blood there was a decrease of SLPI and reg3a in ALA+, which suggest that ALA+ treated grafts are less inflammatory than placebo treated graft. These results show that the use of ALA is safe in LT, induces gene changes that protected from the hypoxia and oxidative stress and reduces the appearance of PRS.