The impact of tranexamic acid on graft function in liver transplantation: A randomised controlled trial

Tranexamic acid (TXA) has been reported to reduce transfusion requirements in liver transplantation (LT). However, clinical evidence regarding the impact of TXA on graft function and other outcomes in liver transplant recipients remains limited. This study aimed to evaluate the effect of TXA on early allograft function following LT. In this prospective, single-centre, randomised study, 89 adult participants scheduled for LT were randomised to receive either TXA or placebo. After anaesthesia induction, a continuous infusion of TXA (10 mg/kg/h) was maintained until portal vein unclamping in the TXA group, while the control group received an equivalent volume of 0.9% saline. The anaesthesia protocol was standardised across both groups. Within 7 days post-transplantation, early allograft dysfunction occurred in 12 of 43 patients in the TXA group compared with 6 of 46 patients in the control group (28% vs 13%, P=0.08). Median aspartate transaminase level was significantly higher in the TXA group on post-operative day 1 compared to the control group (841 vs 622 IU/L, P=0.03). No significant differences were observed between the two groups in transfusion volume, acute kidney injury incidence, thromboembolic events, hospital length of stay, total hospitalisation costs, in-hospital mortality and 180-day survival. TXA administration in liver transplant patients failed to demonstrate beneficial effects on incidence of early graft dysfunction, transfusion requirements or other perioperative outcomes compared to placebo. The routine use of TXA must be undertaken with caution.