Unspecified Complication of Liver TransplantPhase 3NCT01866644
Effectiveness of N-acetylcysteine on Preservation Solution During Liver Transplantation
A Phase 3 study testing N-acetylcysteine and Saline in people with Unspecified Complication of Liver Transplant, run by Instituto de Investigacion Sanitaria La Fe at 1 site in Spain.
Trial summary
Evaluate the effectiveness of the administration produced antioxidant N-acetylcysteine (NAC), decreasing the incidence of primary graft dysfunction and primary failure. The degree of dysfunction will be monitored by the method of LIMON, metabonomics techniques and according to the latest published validation Liver… Read more about this study
- Who is it for?
- Ages 18 to 95 years
- Conditions the study is for
- Unspecified Complication of Liver Transplant
- What is being tested?
- N-acetylcysteine and Saline
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 214 participants
- Where
- 1 siteSpain
- Study dates
- Sep 2011to Jun 2016
- Phase
- Phase 3
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 95 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- All grafts perfused by extraction for liver transplantation.
Who cannot join
- < 18 years
- Allergy to NAC
- Grafts considered invalid for liver transplantation after perfusion
- Hepatitis fulminant
- Retransplantation
- Split
- > 10 hours of cold ischemia
- Patients with asthma
Trial locations and contacts
1 site in 1 country.
About this study
Evaluate the effectiveness of the administration produced antioxidant N-acetylcysteine (NAC), decreasing the incidence of primary graft dysfunction and primary failure. The degree of dysfunction will be monitored by the method of LIMON, metabonomics techniques and according to the latest published validation Liver Transplantation (16 943-949 2010), total billirrubina greater than 10 mg / dl, INR greater than 1.6 in the seventh postoperative day and alanine or aspartate aminotransferase greater than 2000 IU / L in the first seven days. Liver dysfunction is considered, the presence of a transaminase value> 2000 IU / L 1-7 postoperative day or BT> 10 mg / dl or INR> 1.6, both only in the 7th postoperative day (Olthoff et al Liver Transplantation 16,943 -949 2010).
Read the detailed description
The reason of this study is to evaluate the efficacy of the use of n-acetylcysteine in liver transplant, by administering it in the perfusion liquid, at the time of extraction of the liver of the donor to improve the damage caused by ischemia / reperfusion. The dose is 400 mg in the portal perfusion liquid.
The study included all considered valid and perfused livers. Patients are randomized to contain no drug or n-acetylcysteine by randomization. Then analyzed using blood tests and in the receiver and daily during the first seven days post-transplant hepatic dysfunction parameters, in order to objectify if liver function improves after administration of the antioxidant (n-acetylcysteine ). Safety assessments were performed with intraoperative monitoring anesthetic depth, postoperative parameters of liver and kidney function and graft pathologic examination after perfusion.
- Being tested
- N-acetylcysteine, Saline
- Keywords
- Liver transplantation, n-acetylcysteine
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
N-acetylcysteineDrug
Also called Flumil Solution injectable 300 Mg
Bath transplanted liver with N-acetylcysteine
SalineDrug
Also called It's not describe in a protocol
Bath saline transplanted liver
| Study group | Role | What they receive |
|---|---|---|
| N-acetylcysteine | Experimental | At portal level, a cannula is inserted with the usual technique of infusion of 3000 ml of preservation fluid to free fall as containing or not scrambling inserted by the NAC scrub nurse then (400 mg of N-acetylcysteine at 10%, 4 ml ). Receives: Drug: N-acetylcysteine |
| Saline | Placebo comparator | With usual technique Receives: Drug: Saline |
What is being measured
The primary outcome is the main question the study is designed to answer.
The incidence of primary graft dysfunction and primary failure
Evaluate the incidence of primary graft dysfunction and primary failure in each group of treatment.
Measured: One week after treatment
Secondary outcomes (4)
To assess the existence of side effects from the use of n-acetylcysteine on liver preservation solution usual.
Measured: One week after treatment
Reduction of postoperative renal disfunction
Measured: One week after treatment
Assess levels of glutathione stores achieved following administration of NAC
During the harvesting and implantation in the recipient liver three liver biopsies will be performed which will be assessed by determining metabonomics metabolites of the transsulfuration pathway and GSH levels.
Measured: During harvesting
Histological changes
Two biopsies which are going to be done in donor graft before and after reperfusion.
Measured: During harvesting
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted31 May 2013 (estimated)
- Study startSep 2011
- Primary completionJun 2016
- Study completionJun 2016
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (17)Papers the sponsor has linked to this study.
- Other trials for Unspecified Complication of Liver TransplantStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 214 participants (actual)
Sponsor and investigators
- Lead sponsor
- Instituto de Investigacion Sanitaria La Fe
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Rafael Lopez Andujar, PhD, Principal investigator, Hospital Universitario La FeConcepcion Gómez i Gavara, MD, Study chair, Hospital Universitario La Fe
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01866644
- Sponsor's protocol ID
- NAC400
- Status last verified
- Jun 2018
- First submitted
- 18 Apr 2012
- Last updated
- 13 Aug 2018
- Results posted
- No
- Data monitoring committee
- Yes
Publications
Zafarullah M, Li WQ, Sylvester J, Ahmad M. Molecular mechanisms of N-acetylcysteine actions. Cell Mol Life Sci. 2003 Jan;60(1):6-20. doi: 10.1007/s000180300001.
PubMed 12613655De Rosa SC, Zaretsky MD, Dubs JG, Roederer M, Anderson M, Green A, Mitra D, Watanabe N, Nakamura H, Tjioe I, Deresinski SC, Moore WA, Ela SW, Parks D, Herzenberg LA, Herzenberg LA. N-acetylcysteine replenishes glutathione in HIV infection. Eur J Clin Invest. 2000 Oct;30(10):915-29. doi: 10.1046/j.1365-2362.2000.00736.x.
PubMed 11029607Abstracts of the Brain Research Association meeting, Mechanisms of Recovery of Function after Brain Damage. Oxford, U.K., 11 January 1988. Neurosci Lett Suppl. 1988;32:S107-17. No abstract available.
PubMed 2897100Himmelfarb J, Hakim RM. Oxidative stress in uremia. Curr Opin Nephrol Hypertens. 2003 Nov;12(6):593-8. doi: 10.1097/00041552-200311000-00004.
PubMed 14564195Molnar Z, Szakmany T, Koszegi T. Prophylactic N-acetylcysteine decreases serum CRP but not PCT levels and microalbuminuria following major abdominal surgery. A prospective, randomised, double-blinded, placebo-controlled clinical trial. Intensive Care Med. 2003 May;29(5):749-55. doi: 10.1007/s00134-003-1723-1. Epub 2003 Apr 8.
PubMed 12682719Taniyama Y, Griendling KK. Reactive oxygen species in the vasculature: molecular and cellular mechanisms. Hypertension. 2003 Dec;42(6):1075-81. doi: 10.1161/01.HYP.0000100443.09293.4F. Epub 2003 Oct 27.
PubMed 14581295Raj DS, Lim G, Levi M, Qualls C, Jain SK. Advanced glycation end products and oxidative stress are increased in chronic allograft nephropathy. Am J Kidney Dis. 2004 Jan;43(1):154-60. doi: 10.1053/j.ajkd.2003.09.021.
PubMed 14712439Rank N, Michel C, Haertel C, Lenhart A, Welte M, Meier-Hellmann A, Spies C. N-acetylcysteine increases liver blood flow and improves liver function in septic shock patients: results of a prospective, randomized, double-blind study. Crit Care Med. 2000 Dec;28(12):3799-807. doi: 10.1097/00003246-200012000-00006.
PubMed 11153617Taut FJ, Schmidt H, Zapletal CM, Thies JC, Grube C, Motsch J, Klar E, Martin E. N-acetylcysteine induces shedding of selectins from liver and intestine during orthotopic liver transplantation. Clin Exp Immunol. 2001 May;124(2):337-41. doi: 10.1046/j.1365-2249.2001.01531.x.
PubMed 11422213Thies JC, Teklote J, Clauer U, Tox U, Klar E, Hofmann WJ, Herfarth C, Otto G. The efficacy of N-acetylcysteine as a hepatoprotective agent in liver transplantation. Transpl Int. 1998;11 Suppl 1:S390-2. doi: 10.1007/s001470050505.
PubMed 9665023Marczin N, Bundy RE, Hoare GS, Yacoub M. Redox regulation following cardiac ischemia and reperfusion. Coron Artery Dis. 2003 Apr;14(2):123-33. doi: 10.1097/00019501-200304000-00005. No abstract available.
PubMed 12655276Selzner N, Rudiger H, Graf R, Clavien PA. Protective strategies against ischemic injury of the liver. Gastroenterology. 2003 Sep;125(3):917-36. doi: 10.1016/s0016-5085(03)01048-5.
PubMed 12949736D'Amico F, Vitale A, Gringeri E, Valmasoni M, Carraro A, Brolese A, Zanus G, Boccagni P, D'Amico DF, Cillo U. Liver transplantation using suboptimal grafts: impact of donor harvesting technique. Liver Transpl. 2007 Oct;13(10):1444-50. doi: 10.1002/lt.21268.
PubMed 17902131Lopez-Andujar R, Deusa S, Montalva E, San Juan F, Moya A, Pareja E, DeJuan M, Berenguer M, Prieto M, Mir J. Comparative prospective study of two liver graft preservation solutions: University of Wisconsin and Celsior. Liver Transpl. 2009 Dec;15(12):1709-17. doi: 10.1002/lt.21945.
PubMed 19938119Pedotti P, Cardillo M, Rigotti P, Gerunda G, Merenda R, Cillo U, Zanus G, Baccarani U, Berardinelli ML, Boschiero L, Caccamo L, Calconi G, Chiaramonte S, Dal Canton A, De Carlis L, Di Carlo V, Donati D, Montanaro D, Pulvirenti A, Remuzzi G, Sandrini S, Valente U, Scalamogna M. A comparative prospective study of two available solutions for kidney and liver preservation. Transplantation. 2004 May 27;77(10):1540-5. doi: 10.1097/01.tp.0000132278.00441.cf.
PubMed 15239618
Study at a glance
From the registry record, last updated by the sponsor on 13 Aug 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effectiveness of N-acetylcysteine on Preservation Solution During Liver Transplantation
- ClinicalTrials.gov ID
- NCT01866644
- Acronym / sponsor ID
- NAC400
- Keywords
- Liver transplantation, n-acetylcysteine
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 214 participants (actual)
- Lead sponsor
- Instituto de Investigacion Sanitaria La FeUniversity, hospital or other
- Study start
- Sep 2011 (actual)
- Primary completion
- Jun 2016 (actual)
- Study completion
- Jun 2016 (actual)
- First posted
- 31 May 2013 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Evaluate the effectiveness of the administration produced antioxidant N-acetylcysteine (NAC), decreasing the incidence of primary graft dysfunction and primary failure. The degree of dysfunction will be monitored by the method of LIMON, metabonomics techniques and according to the latest published validation Liver Transplantation (16 943-949 2010), total billirrubina greater than 10 mg / dl, INR greater than 1.6 in the seventh postoperative day and alanine or aspartate aminotransferase greater than 2000 IU / L in the first seven days. Liver dysfunction is considered, the presence of a transaminase value> 2000 IU / L 1-7 postoperative day or BT> 10 mg / dl or INR> 1.6, both only in the 7th postoperative day (Olthoff et al Liver Transplantation 16,943 -949 2010).
Detailed description
The reason of this study is to evaluate the efficacy of the use of n-acetylcysteine in liver transplant, by administering it in the perfusion liquid, at the time of extraction of the liver of the donor to improve the damage caused by ischemia / reperfusion. The dose is 400 mg in the portal perfusion liquid.
The study included all considered valid and perfused livers. Patients are randomized to contain no drug or n-acetylcysteine by randomization. Then analyzed using blood tests and in the receiver and daily during the first seven days post-transplant hepatic dysfunction parameters, in order to objectify if liver function improves after administration of the antioxidant (n-acetylcysteine ). Safety assessments were performed with intraoperative monitoring anesthetic depth, postoperative parameters of liver and kidney function and graft pathologic examination after perfusion.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| N-acetylcysteine | Experimental | Drug: N-acetylcysteineAt portal level, a cannula is inserted with the usual technique of infusion of 3000 ml of preservation fluid to free fall as containing or not scrambling inserted by the NAC scrub nurse then (400 mg of N-acetylcysteine at 10%, 4 ml ). |
| Saline | Placebo comparator | Drug: SalineWith usual technique |
Who may qualify
- Ages
- 18 to 95 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- All grafts perfused by extraction for liver transplantation.
Key exclusion criteria (8 listed)
- < 18 years
- Allergy to NAC
- Grafts considered invalid for liver transplantation after perfusion
- Hepatitis fulminant
- Retransplantation
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| N-acetylcysteineAlso: Flumil Solution injectable 300 MgBath transplanted liver with N-acetylcysteine | Drug | N-acetylcysteine |
| SalineAlso: It's not describe in a protocolBath saline transplanted liver | Drug | Saline |
Primary outcome
The incidence of primary graft dysfunction and primary failure
Time frame: One week after treatment
Evaluate the incidence of primary graft dysfunction and primary failure in each group of treatment.
4 secondary outcomes
To assess the existence of side effects from the use of n-acetylcysteine on liver preservation solution usual.
Time frame: One week after treatment
Reduction of postoperative renal disfunction
Time frame: One week after treatment
Assess levels of glutathione stores achieved following administration of NAC
Time frame: During harvesting
Histological changes
Time frame: During harvesting
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 13 Aug 2018.
- Background: PubMed 12613655Zafarullah M, Li WQ, Sylvester J, Ahmad M. Molecular mechanisms of N-acetylcysteine actions. Cell Mol Life Sci. 2003 Jan;60(1):6-20. doi: 10.1007/s000180300001.
- Background: PubMed 11029607De Rosa SC, Zaretsky MD, Dubs JG, Roederer M, Anderson M, Green A, Mitra D, Watanabe N, Nakamura H, Tjioe I, Deresinski SC, Moore WA, Ela SW, Parks D, Herzenberg LA, Herzenberg LA. N-acetylcysteine replenishes glutathione in HIV infection. Eur J Clin Invest. 2000 Oct;30(10):915-29. doi: 10.1046/j.1365-2362.2000.00736.x.
- Background: PubMed 2897100Abstracts of the Brain Research Association meeting, Mechanisms of Recovery of Function after Brain Damage. Oxford, U.K., 11 January 1988. Neurosci Lett Suppl. 1988;32:S107-17. No abstract available.
- Background: PubMed 14564195Himmelfarb J, Hakim RM. Oxidative stress in uremia. Curr Opin Nephrol Hypertens. 2003 Nov;12(6):593-8. doi: 10.1097/00041552-200311000-00004.
- Background: PubMed 12682719Molnar Z, Szakmany T, Koszegi T. Prophylactic N-acetylcysteine decreases serum CRP but not PCT levels and microalbuminuria following major abdominal surgery. A prospective, randomised, double-blinded, placebo-controlled clinical trial. Intensive Care Med. 2003 May;29(5):749-55. doi: 10.1007/s00134-003-1723-1. Epub 2003 Apr 8.
- Background: PubMed 14581295Taniyama Y, Griendling KK. Reactive oxygen species in the vasculature: molecular and cellular mechanisms. Hypertension. 2003 Dec;42(6):1075-81. doi: 10.1161/01.HYP.0000100443.09293.4F. Epub 2003 Oct 27.
- Background: PubMed 14712439Raj DS, Lim G, Levi M, Qualls C, Jain SK. Advanced glycation end products and oxidative stress are increased in chronic allograft nephropathy. Am J Kidney Dis. 2004 Jan;43(1):154-60. doi: 10.1053/j.ajkd.2003.09.021.
- Background: PubMed 11153617Rank N, Michel C, Haertel C, Lenhart A, Welte M, Meier-Hellmann A, Spies C. N-acetylcysteine increases liver blood flow and improves liver function in septic shock patients: results of a prospective, randomized, double-blind study. Crit Care Med. 2000 Dec;28(12):3799-807. doi: 10.1097/00003246-200012000-00006.
- Background: PubMed 11422213Taut FJ, Schmidt H, Zapletal CM, Thies JC, Grube C, Motsch J, Klar E, Martin E. N-acetylcysteine induces shedding of selectins from liver and intestine during orthotopic liver transplantation. Clin Exp Immunol. 2001 May;124(2):337-41. doi: 10.1046/j.1365-2249.2001.01531.x.
- Background: PubMed 9665023Thies JC, Teklote J, Clauer U, Tox U, Klar E, Hofmann WJ, Herfarth C, Otto G. The efficacy of N-acetylcysteine as a hepatoprotective agent in liver transplantation. Transpl Int. 1998;11 Suppl 1:S390-2. doi: 10.1007/s001470050505.
- Background: PubMed 12655276Marczin N, Bundy RE, Hoare GS, Yacoub M. Redox regulation following cardiac ischemia and reperfusion. Coron Artery Dis. 2003 Apr;14(2):123-33. doi: 10.1097/00019501-200304000-00005. No abstract available.
- Background: PubMed 12949736Selzner N, Rudiger H, Graf R, Clavien PA. Protective strategies against ischemic injury of the liver. Gastroenterology. 2003 Sep;125(3):917-36. doi: 10.1016/s0016-5085(03)01048-5.
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Rafael Lopez Andujar, PhD principal investigator
Hospital Universitario La Fe
Concepcion Gómez i Gavara, MD study chair
Hospital Universitario La Fe
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing N-acetylcysteine and Saline in people with Unspecified Complication of Liver Transplant, run by Instituto de Investigacion Sanitaria La Fe at 1 site in Spain.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 13 Aug 2018. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The incidence of primary graft dysfunction and primary failure (time frame: One week after treatment). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01866644, which also lists 17 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Aug 2018.