Transplant Trial Watch

α-lipoic acid reduces postreperfusion syndrome in human liver transplantation - a pilot study

Casciato P, Ambrosi N, Caro F, et al.

Transpl Int. 2018; 31(12):1357-1368.


Aims
To determine the efficacy and safety of α-lipoic acid (ALA) in liver transplantation (LT).

Interventions
Donor grafts were randomized to receive either ALA or placebo before the cold ischemia time. Just before graft reperfusion, patients transplanted with an ALA-perfused graft received 600 mg of intravenous ALA, while patients with the nonperfused graft received placebo in identical conditions.

Participants
Patients were adult (18–69 years), receiving a liver transplant and received either ALA (n=22) or placebo (n=18).

Outcomes
Donors were analyzed according to whether they were optimal donors or expanded criteria donors. In transplant recipients, early clinical endpoints were evaluated to determine the effect of ALA in patients undergoing LT including the occurrence of severe postreperfusion syndrome, rejections, graft and patient survival, the levels of plasma alarmins (REG3a/PAP and SLPI), and blood biochemical data that indicated liver and kidney function.

Follow-up
2 years

CET Conclusions
This is a well conducted, double-blind, randomised controlled trial in liver transplantation. Unfortunately, it was not powered for clinical outcomes. The main outcomes of interest were real-time PCR results and plasma levels of stress-response markers. Alpha-lipoic acid was associated with some difference in hypoxia-related gene expression, but not all those that were tested. Alpha-lipoic acid was associated with decreased levels of markers of systemic stress response (SLPI and PAP). Whilst the study was well-conducted I would be cautious about extrapolating its results too far.

Jadad score
4

Data analysis
Per protocol analysis

Allocation concealment
Yes

Trial registration
None

Funding source
Industry funded