Transplant Trial Watch

Benefits of N-acetylcysteine on liver functions in living donor hepatectomy

Ammar, M. A. and A. M. H. Abdou.

Indian Journal of Anaesthesia 2020; 64(3): 204-209.

This study aimed to examine the effects of using N-Acetylcysteine (NAC) in living liver donors who have undergone donor hepatectomy.

Patients were randomly assigned to receive either NAC infusion or ringer acetate infusion.

50 right-lobe living liver donors.

The primary endpoint was the assessment of serum lactate levels. The secondary endpoints included post-operative mortality or morbidity, duration of stay at the Intestive Care Unit (ICU), urine output and serum creatitine levels measured on ICU admisson and after 24 hours and 48 hours, and liver function tests including alanine transaminase (ALT) levels, total bilirubin and international normalisation ratio (INR).

Not reported

CET Conclusions
This small single-centre RCT investigated the use of N-acetylcysteine in the post-operative management of right-lobe living liver donors. Control patients received ringer’s acetate, but there was no blinding. The authors report significant reductions in early post-operative donor lactate and INR levels, with no difference in other liver function tests or ITU stay. Whilst interesting, these results require validation in a larger, blinded study that also investigates the potential clinical benefits in greater detail. Both lactate and INR can be manipulated by alterations in fluid and anticoagulant management, and so the lack of blinding creates a risk of performance bias.

Jadad score

Data analysis
Per protocol analysis

Allocation concealment

Trial registration - NCT03634566

Funding source
No funding received