A randomized trial of ascorbic acid for the prevention of post-reperfusion syndrome during liver transplantation

Post-reperfusion syndrome (PRS) is a critical hemodynamic complication during liver transplantation, characterized by a significant drop in mean arterial pressure and associated with increased morbidity and mortality, systemic inflammation, and ischemia-reperfusion injury. Ascorbic acid (AA), with its antioxidant and anti-inflammatory properties, has been proposed as a potential therapeutic intervention.

A single-center, double-blind, randomized controlled trial was conducted at the Hospital Universitario Ramón y Cajal, Madrid. Patients undergoing liver transplantation were randomly assigned to receive either 1500 mg of intravenous AA during the anhepatic phase (vitamin C-treated group) or 0.9% saline as a placebo (control group). The primary endpoint was PRS incidence. The secondary outcomes included inflammatory cytokine levels, postoperative renal function, and patient/graft survival.

Thirty-nine patients were randomized (20 controls and 19 AA-treated patients). The incidence of PRS was 30% in the control group and 10.5% in the AA group (p=0.235). Postoperative renal failure occurred more frequently in the AA group (68.4%) than in the control group (35%) (p=0.037). Four AA-treated patients (21.1%) required re-transplantation. No significant differences in cytokine levels were observed between the groups, although increases in IL-6, IL-8, and IL-10 levels were noted in patients with PRS, suggesting a stronger inflammatory response.

AA supplementation demonstrated a noticeable trend toward reducing PRS during liver transplantation, although this was not statistically significant. An increase in renal failure and the need for re-transplantation were observed in the AA-treated group. Although the study suggests potential benefits, its small sample size limits the conclusions, pointing to the need for larger multicenter trials to determine the optimal dosage and timing.