An evaluation of the safety and preliminary efficacy of peri- and post- operative treprostinil in preventing ischemia and reperfusion injury in adult orthotopic liver transplant recipients.

Orthotopic liver transplantation (OLT) is the only treatment option for various end-stage liver diseases. Ischemia and reperfusion (I/R) injury is one of the unavoidable complications/conditions in OLT. In 2019, a total of 8896 livers were transplanted of which >94% organs were procured from deceased donors. An increase in the use of extended criteria donor (ECD) livers for transplantation further unraveled the role of hepatic I/R injury on short-term and long-term graft outcomes. Despite promising outcomes with the use of antioxidants, free radical scavengers, and vasodilators; I/R mediated liver injury persists and significantly influences the overall clinical outcomes. Treprostinil, a synthetic prostacyclin I2 (PGI2 ) analog, due to its vasodilatory property, antiplatelet activity and its ability to down-regulate pro-inflammatory cytokines can potentially minimize I/R injury. We investigated the safety and preliminary efficacy of continuous intravenous infusion of treprostinil in liver transplant recipients in a prospective, single-center, non-randomized, interventional study. Deceased donor liver transplant recipients tolerated continuous infusion of treprostinil up to 5 ng/kg/min for 120 hours with, no occurrence of primary graft non-function (PNF), minimized need for ventilation support, reduced hospitalization time, 100 % graft and patient survival and improved hepato-biliary excretory function comparable to normal healthy adults. In conclusion, treprostinil can be administered to liver transplant patients safely during the perioperative period.