MTP8.15 Role of N-acetylcysteine use in traumatic liver injury: a systematic review

Introduction and Objectives The role of N-acetylcysteine (NAC) in paracetamol-induced liver injury is well established. Emerging evidence has also identified a role for NAC in non-paracetamol-induced liver injury. Its antioxidant properties have shown value in reducing oxidative stress in ischaemia-reperfusion and other drug-induced injuries [1]. Research for NAC following liver transplantation [2], and its potential role in major hepatectomies is still ongoing [3]. This systematic review aimed to explore literature for use of NAC in patients with traumatic liver injuries. Method A comprehensive search of Pubmed, Embase, Google Scholar and Cochrane Library databases were performed to identify relevant studies from 2014-2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. The study was registered on PROSPERO, CRD42024605773. Result Fifty-nine papers were identified, however all described injury from controlled trauma (hepatectomies) or ischaemia-reperfusion injury. No studies specifically addressed the use of NAC following blunt or penetrating liver trauma. In those evaluating NAC following major hepatectomies, its use was not associated with significant postoperative benefits. However, in liver transplant, NAC significantly reduced incidence of primary graft nonfunction and postoperative complications. Conclusion Controversy exists regarding the use of NAC in liver surgery. In major hepatectomies, further research has been advocated, but in liver trauma there are currently no studies addressing the impact of NAC on outcomes. Given the role of NAC in non-traumatic liver injuries, and a potential role in liver transplantation, there is value in future research investigating the use of NAC in blunt and penetrating liver trauma.