N-acetylcysteine (NAC) may improve liver transplant outcomes

In a prospective randomized controlled study recently published in Liver Transplantation (Liver Transpl 19:135-144, 2013), Italian investigators assessed the role of infusing N-acetylcysteine (NAC) into donor livers on post-transplant outcomes. The primary outcome was graft survival. Higher graft survival rates were seen in those patients who had received NAC infused livers – 93% and 90% at 3 months and 12 months, respectively, compared to 82% and 70% at 3 months and 12 months, respectively, in the group that did not receive the N-acetylcysteine infusions. Researchers believe that ischemia and reperfusion injury caused by oxidative stress contributes to graft survival. Infusing N-acetylcysteine one hour prior to liver harvesting and infusing it again into the portal vein before cross-clamping is believed to replenish the main endogenous antioxidant glutathione. Investigators believe that NAC therapy may present a cost-effective strategy to improve graft and patient survival in an era of organ shortage and need for use of suboptimal organs.