Background: N-acetylcysteine (NAC) has been used in post-orthotopic liver transplant (OLT) patients for the proposed mechanism of preventing tissue damage of the newly transplanted organ from reactive oxygen species. This in turn may reduce cytokines and inflammation making oxygen delivery to the newly transplanted organ easier, which can lead to decreased reperfusion injury.

Objective: To evaluate the efficacy and safety of NAC use in patients post-OLT. Graft survival was examined as the primary outcome with post-operative bleeding requiring an exploratory laparotomy, biliary complications, and length of hospitalization.

Methods: The study is a retrospective review of the impact of NAC on solitary livers transplanted between January 2010 and June 2014. Student's t-test was used to compare continuous variables and Chi-Square test was used to compare categorical variables. Kaplan-Meier Method and Cox Proportional Hazards model were used to analyze outcomes post-OLT.

Results: 118 solitary livers were included with 50 (42%) receiving NAC post-OLT and 68 (58%) not receiving NAC. Those who received NAC had similar MELD at transplant, weight, age, and gender compared to those who did not. The average length of hospitalization post-OLT in the NAC group was 19.5 +/- 26.4 days vs. 14.1 +/- 11.0 days in the no NAC group (p=0.13.) Post-operative bleeding was similar between groups. A higher percent of those who received NAC had a DCD organ (32% vs. 15%, p=0.02). NAC patients had higher initial post-OLT AST and ALT compared to those who did not receive NAC (2604 +/- 1761 vs. 1192 +/- 1026, p<0.01 and 1218 +/- 1059 vs. 617 +/- 562, p<0.01, respectively.) The cold ischemia time was longer in those who received NAC vs. those who did not (8.9 +/- 2.6 vs. 7.5 +/- 2.6, p=0.01.) The incidence of biliary complications was similar between NAC and no NAC (18.6% vs. 31.4% at 6 months post-OLT, p=0.13.) Graft Survival was similar between NAC and no NAC (91.8% vs. 94.0% at 1 year post-OLT, p=0.71.)

Conclusion: Further examination of association between biliary outcomes and NAC in a multivariable model also did not reach statistical significance. This could be due to our limited sample size, or overshadowed by more important variables like year of transplant or donor status. These results support the further need for research to fully understand the role of NAC use in post-operative liver transplant patients.

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