Liver Transplant
Conditions
Keywords
Liver Transplant, Prostacyclin, Treprostinil sodium, Remodulin, Reperfusion Injury, Primary Nonfunction
Brief summary
Patients undergoing orthotopic liver transplant will experience some degree of clinical and/or biochemical hepatic dysfunction. This early injury is known as primary graft dysfunction and varies from minor abnormalities to primary nonfunction. Prostaglandin-class drugs, including prostacyclin and its analogs, could represent an important advance toward the goal of reducing transplant related morbidity, mortality and associated costs by providing these benefits.
Detailed description
In vitro and in vivo research has consistently demonstrated an array of potential beneficial effects of prostanoids under both immune and non-immune circumstances relevant to liver allografts. (1-3) Recent reviews summarize the pharmacologic rationale and nonclinical and clinical experience supporting for the use of prostanoids, including prostacyclin and its analogs, in reducing early morbidity and mortality associated with liver transplantation. Prostaglandin-class drugs, including prostacyclin and its analogs, could represent an important advance toward the goal of reducing transplant related morbidity, mortality and associated costs by providing these benefits. Additionally, the reduction in serum creatinine and reduced need for post-operative dialysis observed in some studies has implications in protecting the kidneys from the nephrotoxic affects of the immunosuppressant agents, especially during the early post-operative period. As a chemically stable analog of prostacyclin (PGI2), peri-operative intravenous administration of Remodulin is hypothesized to ameliorate or prevent reperfusion damage and thereby decrease hospitalization time and improve the clinical outcome of liver transplantation, compared to placebo control. Remodulin, as a prostanoid, is expected to facilitate restoration of the blood supply to the revascularized graft, and to provide the well-characterized protective effects of this class of compounds in liver transplant patients.
Interventions
A single dose strength of treprostinil sodium (1.0 mg/mL) and matching placebo will be provided in 20-mL multi-dose vials. The study drug will be started after induction of anesthesia and increased incrementally to a target dose of 10 ng/kg/min during surgery and 48 hours post-operative
DRUGPlacebo
Sponsors
University of Pittsburgh Medical Center
United Therapeutics
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Accepted as a liver transplant candidate at the University of Pittsburgh Medical Center * Be receiving a cadaver donor liver transplant * Treated in accordance with the standard of care protocol(s) in effect for liver transplant recipients at the University of Pittsburgh Medical Center.
Exclusion criteria
* Receiving a living done liver transplant * Receiving a donor liver with a cold ischemia time less that 6 hours * Receiving a donor liver with macrosteatosis greater than 30% * Receiving any investigation drug with the except of alemtuzamab (Camphath) * Failed liver transplant in previous 180 days * Prior organ transplant or cell infusion * Undergoing multi-organ transplant * Pregnant or nursing female
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of the initial hospitalization (days) following transplantation | up to 180 days | — |
| Area under the curve (AUC) of serum aspartate transaminase (AST) levels. | 7 days | The difference in serum AST as measured by AUC during the first seven days post-transplant will be compared between placebo and Remodulin treatment groups. AST is a serum transaminase marker of hepatic injury, and the AUC of AST levels represents the total magnitude of injury the liver experiences against time. |
Secondary
| Measure | Time frame |
|---|---|
| Total costs for initial transplant hospitalization | up to 180 days |
| Serum AST and alanine transaminase (ALT ) levels after transplant (Peak and Area Under the Curve [AUC]) | 7 days |
| Primary allograft nonfunction defined as patient death or retransplant within 30 days due to liver failure | 30 days |
| Intra-operative blood product usage | 1 day |
| Subject survival at | Day 30, 90, and 180 |
| Post-transplant renal function | 30 days |
| Duration of time spent in the intensive care unit (ICU; days) during the initial hospitalization. | up to 180 days |
| Graft survival | 30 days, 90 days and 180 days |
| Death from any cause | 180 days |
Countries
United States
Outcome results
None listed