The efficacy of Intravenous amino acids in reducing the occurrence of AKI after Live Donor Liver Transplant: An Open Label Randomized Trial

Acute Kidney Injury (AKI) remains a common and serious complication following live donor liver transplantation (LDLT), with incidence rates ranging upto 60%. AKI increases patient morbidity, hospital stay, need for renal replacement therapy, and mortality. Several risk factors contribute to post-transplant AKI, including intraoperative hemodynamic shifts, ischemia-reperfusion injury, and immunosuppressive nephrotoxicity. Emerging evidence suggests that perioperative administration of intravenous amino acids  reduces the incidence of AKI by Increasing renal perfusion, renal oxygenation, and GFR.

This prospective, open-label, randomized controlled trial aims to evaluate the efficacy of intravenous amino acid infusion in reducing AKI after LDLT. Eligible adult patients undergoing LDLT will be randomized into two groups: one receiving Continuous infusion of a L-amino acids mixture in a dose of 2 g/kg dry body weight/day (to a maximum 100 g/day) after induction of anesthesia and insertion of CVP line till 72 hours after treatment initiation, and the other receiving standard management. The primary outcome is the incidence of AKI as per KDIGO criteria within 7 days of transplant. Secondary outcomes include early graft dysfunction, need for renal replacement therapy, ICU and inhospital stay, and  Major Morbidity. serum NGAL and cystatin C levels will be assessed as early AKI biomarker. The findings of this study will help establish whether amino acid infusion can be a cost-effective, safe, and easily implementable strategy for AKI prevention in liver transplant patients, thereby improving outcomes.