Evaluation of Serum Taurine as a Prognostic Marker for Graft Function in Adult Egyptian Patients Undergoing Living Donor Liver Transplant (Taurine/LDLT)

Evaluation of Serum Taurine as a Prognostic Marker for Graft Function in Adult Egyptian Patients Undergoing Living Donor Liver Transplant : A Prospective Study

Although the hepatoprotective properties of taurine are well established, however the correlation of the perioperative serum level of this amino acid in the recipients of living donor liver transplantation ( LDLT ) and graft function has not been investigated so far. In the present study, we proposed to examine the serum taurine as a prognostic marker for graft function in adult Egyptian patients undergoing LDLT

Study Overview

• Status: Completed
• Conditions: Taurine
• Intervention / Treatment: Diagnostic test: serum taurine

Detailed Description

• All selected adult patients undergoing LDLT will be admitted to the ICU post LDLT
• Preoperative assessment and preparation will be done according to the standard protocol of the hospital. After full clinical examinations using MELD score corrected for serum sodium level ), imaging techniques (Abdominal U.S; abdominal triphasic CAT Scan, liver biopsy, CT volumetry, upper and lower GIT endoscopy, CT chest, bone scan in HCC patients, renal scan in patients with urinary creatinine clearance < 60 ml/min), pulmonary function test, carotid duplex and dobutamine ECHO will be done for all recipients .
• Serum level of AST, ALT, bilirubin, albumin, ALP, GGT, prothrombin, INR, partial thrombin time, factor V, fasting blood glucose, CBC, CRP, Procalcitonin, urea, creatinine, urinary creatinine clearance, serum electrolytes, urine and stool analysis will be done for all patients.
• Analysis of serum levels of specific liver tumor markers including AFP, beside taurine as a possible new marker will be done for all patients .
• HCV and HBV will be detected for all patients by PCR technique.
• CMV IgM , EBV IgM ,HSV IgM will be done for all patients.
• After 12 hours fasting, 10 ml of venous blood will be collected, in plain tube and allowed to clot for 1/2 an hour. Then, it will be centrifuged at 3,000 rpm for 10 min. The serum will be separated and stored at -20 Cº to avoid loss of biological activity until the batch analysis for serum taurine which will be measured four times for the recipient ( preoperative before induction of anesthesia , 7, 14 days and 30 days post transplant ) by high performance liquid chromatography (HPLC) .

Recipient patients will be divided into 3 groups according to preoperative serum taurine .

• Group 1 ( > 30 μmol/L) (20 cases)
• Group 2 (30-20 μmol/L) (20 cases)
• Group 3 (< 20 μmol/L ) (20 cases)

Intraoperatively, both standard anesthetic and piggyback techniques for hepatic transplantation will be performed by the same anesthesia and surgical team who will be blinded to study medication. Intraoperative blood loss, graft weight, graft weight to recipient weight ratio (GWRWR), blood products transfused, and intraoperative adverse events will be recorded. At the end of surgery, patients will be transferred to the ICU and will be monitored and receive the standard protocol for postoperative management after liver transplantation .

All patients will be assessed for primary graft function (PGF) on a daily basis during the first week post-transplant. Primary graft dysfunction includes one or more of the following variables: (1) bilirubin ≥10 mg/dL on postoperative day 7; (2) INR ≥1.6 on postoperative day 7; and (3) ALT or AST >2000 IU/L within 7 postoperative days.

The primary outcome include correlation between serum taurine levels ( μmol/L) of recipients and graft function which will be detected by liver profile. Secondary outcomes include 30 days mortality (days), the duration of ICU and hospital stays (days) and any recorded post operative complications.

• Study Type: Observational
• Enrollment (Actual): 60

Contacts and Locations

Study Locations

• Egypt
  • Ain Shams University Specialized Hospital
    • Cairo, Ain Shams University Specialized Hospital, Egypt
      • Hanaa El Gendy

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

After reviewing of literature, no previous similar research was done before to study the effect of recipient serum taurine on graft survival after living donor liver transplant). So considering an exploratory study, the study will include 20 cases with taurine >30 μmol/L, 20 cases with taurine 20-30 μmol/L and 20 cases with taurine <20 μmol/L (60 total).

Description

Inclusion Criteria:

• Recipient age ≥18 years.
• Donor age between 18 and 45 years
• ABO group compatibility with the recipient
• Normal psychological workup.

Exclusion Criteria:

• Recipients patients with pre-existing renal failure requiring hemodialysis or continuous hemofiltration, glomerular filtration rate ≤ 30 ml /min by renal scan, ..
• Re-transplant
• HA1C > 7%
• Pregnancy.
• Donors with fatty liver.
• Estimated remnant liver volume for donor is < 30% of total liver volume.
• Donor body mass index > 28 kg/m².
• Donor with abnormal biliary anatomy.
• Donor with steatosis > 10%.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Taurine > 30 μmol/L; serum taurine level	Diagnostic test: serum taurine; blood sample for serum taurine level
Taurine 30-20 μmol/L; serum taurine level	Diagnostic test: serum taurine; blood sample for serum taurine level
Taurine < 20 μmol/L; serum taurine level	Diagnostic test: serum taurine; blood sample for serum taurine level

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Taurine level in micro mol/L	Taurine level preoperative, 7th,14 th and 30 days post liver transplantation will be assesd and correlated with graft function	7 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Seventh day syndrome, 30 days mortality (days), the duration of ICU and hospital stays (days).	Taurine level will be correlated with these parameters	7 months

Collaborators and Investigators

• Sponsor: Ain Shams University

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2019
• Primary Completion (Actual): May 30, 2020
• Study Completion (Actual): May 30, 2020

Study Registration Dates

• First Submitted: July 31, 2019
• First Submitted That Met QC Criteria: August 4, 2019
• First Posted (Actual): August 6, 2019

Study Record Updates

• Last Update Posted (Actual): August 24, 2020
• Last Update Submitted That Met QC Criteria: August 21, 2020
• Last Verified: August 1, 2020

More Information

Terms related to this study

• Keywords: Taurine/graft function/LDLT
• Other Study ID Numbers: IRB 0006379

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No