Prostaglandins have a broad spectrum of action. They are potent vasodilators, mediators of the inflammatory response, and have been found to decrease both humoral and cellular immune responses. Specifically in the liver, prostaglandins of the E series have been shown experimentally to have immunologic, cytoprotective, and vascular effects.' In animal models of hepatic necrosis induced by galactosamine, ethanol, endotoxin, or virus, early use of prostaglandins improves survival in treated animals.1~2 Because of these known hepatic effects, prostaglandins have been used clinically to treat patients with fulminant hepatic failure as well as liver transplant recipients.
In the article by Henley et a13 that appears in this issue, 160 liver transplant recipients were randomized to receive either a prostaglandin infusion, starting at time of transplantation, or a placebo. Endpoints included patient and graft survival, length of intensive care unit and hospital stay, infectious complications, need for reoperation or dialysis, primary nonfunction of the graft, incidence of rejection, and overall mortality. Given previous reports on the use of prostaglandin in liver recipients with primary nonfunction (PNF it is interesting that there was no difference in the incidence of PNF or in the need for retransplantation in the prostaglandin group. Also of note is the fact that despite prostaglandin's immunosuppressive properthere was no significant difference in the incidence of rejection between the two groups. Although there was no difference in mortality or graft survival, benefits included decreased need for postoperative dialysis and lowered incidence of reintubation and subsequent need for tracheotomy, and a general reduction in reoperations for various indications. These factors resulted in significant decreases in both ICU and hospital stay in the prostaglandin group. In addition, in a recent a b ~t r a c t , ~ Henley et a1 reported that a reduced need for transfusion in the patients who received prostaglandin was an important contributing factor in decreased overall cost per patient.
Clinical studies of prostaglandin in patients undergoing liver transplantation have found it to be effective in recipients with poor early graft function. Greig et a14 reported that prostaglandin El (PGE,