Table 4.
Design and key summary findings of clinical studies evaluating N-acetylcysteine in liver transplantation (n = 9)
| First author/year | Experimental design | NAC intervention | Number treated with NAC | Number without NAC | Endpoint: Liver function | Endpoint: Graft/patient survival |
|---|---|---|---|---|---|---|
| Bromley et al. 199543 | Double-blind, Placebo-controlled RCT | Recipient: 150 mg/kg NAC over 15 min followed by 12.5 mg/kg for 4 h & 6.25 mg/kg for remainder. | 25 | 25 | Higher AST in NAC group at day 6. | Not reported. |
| Regueira et al. 199744 | Cohort series: group receiving NAC and group without NAC. | To donor 6 g NAC iv 1h before retrieval. | 25 | 37 | SGOT: 825.97 control Vs 353.56 NAC | No primary failure. Poor graft function – 5 in control 0 in NAC. |
| Thies et al. 199845 | RCT | 150 mg/kg before re-perfusion. Then 50 mg/kg over 4 h. | 30 | 30 | AST -NAC 773 ± 133 vs control 1102 ± 225 U/L | Not reported |
| Steib et al. 199846 | RCT | 150 mg/kg NAC over 30 minutes at SVC anastomosis Followed by 50 mg/kg for 4 h and 100 mg/kg for 16 h. | 30 | 30 | No difference in ALT or AST. | No difference |
| Bucuvalas et al. 200147 | Open-label, non-randomised, comparative study | 70 mg/kg at reperfusion and 12 hrly for 6 days (in conjunction with PGE1). | 12 | 13 | Peak ALT 499 IU/L NAC vs 867 IU/L control. | 100% at 3 months in both groups. |
| Taut et al. 200148 | Non randomized case-control | 150 mg/kg NAC at reperfusion. 50 mg/kg over 4 hours. 100 mg/kg over 16 hours. | 9 | 10 | Not reported | Not reported |
| Weigand et al. 200149 | RCT | liver flushed with 1l Ringer's + 1000 mg/L NAC. Plus 150 mg/kg NAC before reperfusion + continuous infusion of 50 mg/kg NAC for 4 hr. Then 100 mg/kg NAC 16 hr | 10 | 10 | No significant difference in serum AST, ALT and total bilirubin. | Not reported |
| Khan et al. 200550 | RCT | Donors: 150 mg/kg NAC before cardiac arrest And 75 mg/kg during cold phase. Recipients did not receive NAC. | 9 | 9 | No difference in trans-aminase. | Not reported. |
| Santiago et al. 200851 | Double-blind, Placebo-controlled RCT | Recipients 100 mg/kg after 15 minutes into anhepatic phase followed by 50 mg/kg infusion over 24 h. | 25 | 25 | Not reported | Not reported |
AST = Aspartate transaminase, SGOT = Serum glutamic oxaloacetic transaminase (AST), ALT = Alanine transaminase, ICAM1 = Intercellular adhesion molecule 1, VCAM1= vascular cell adhesion molecule 1, IL4 = interleukin 4.