Evaluation of Serum Taurine as a Prognostic Marker for Graft Function in Adult Egyptian Patients Undergoing Living Donor Liver Transplant
Condition: Taurine
Study type: Observational [Patient Registry]

Summary: 
      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
    

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.
    

Intervention name(s): serum taurine
Intervention type(s): Diagnostic Test
Intervention description(s): blood sample for serum taurine level
Observational model: Cohort
Time perspective: Prospective
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).
      
Keywords: Taurine/graft function/LDLT