for people ages 18 years and up (full criteria)
study started
estimated completion
Principal Investigator
by Michael P Bokoch, MD, PhD (ucsf)
Headshot of Michael P Bokoch
Michael P Bokoch



Acute kidney injury (AKI), or worsening kidney function, is a common complication after liver transplantation (20-90% in published studies). Patients who experience AKI after liver transplantation have higher mortality, increased graft loss, longer hospital and intensive care unit stays, and more progression to chronic kidney disease compared with those who do not. In this study, half of the participants will have their body temperature cooled to slightly lower than normal (mild hypothermia) for a portion of the liver transplant operation, while the other half will have their body temperature maintained at normal. The study will evaluate if mild hypothermia protects from AKI during liver transplantation.

Official Title

Mild Hypothermia and Acute Kidney Injury in Liver Transplantation (MHALT) Trial


This study is a single-blinded, randomized controlled trial of mild hypothermia during liver transplantation to provide protection from AKI. Participants will be randomized to normothermia (36.5-37.5 °C) versus mild hypothermia (34-35 °C) during a portion of the liver transplant operation. The protocol is based on preliminary data from rodent models showing that hypothermia protects the kidneys from ischemia-reperfusion injury, as well as studies in deceased organ donors showing that cooling improves post-transplant organ function. Temperature will be maintained with standard techniques plus a minimally-invasive esophageal cooling device that is approved by the U.S. Food and Drug Administration. The investigators hypothesize that mild hypothermia will reduce the incidence and severity of AKI after LTx. Standard surrogates (e.g., change in serum creatinine, need for initiation of dialysis) and biomarkers will be used to assess the severity of kidney injury.


Cirrhosis, End Stage Liver Disease, Acute Kidney Injury, Liver Transplant; Complications, Chronic Kidney Diseases, Hepatitis c, Hepatitis B, NASH - Nonalcoholic Steatohepatitis, Alcoholic Cirrhosis, Hepatocellular Carcinoma, Hypothermia, NGAL - Neutrophil Gelatinase-associated Lipocalin, Hepatitis A, Hepatitis, Liver Cirrhosis, Liver Diseases, Fatty Liver, Non-alcoholic Fatty Liver Disease, Alcoholic Liver Cirrhosis, Kidney Diseases, Chronic Renal Insufficiency, Fibrosis, Wounds and Injuries, Esophageal cooling/warming device, Mild hypothermia, Normothermia, Mild hypothermia & Esophageal cooling/warming device, Normothermia & Esophageal cooling/warming device


You can join if…

Open to people ages 18 years and up

- Liver transplantation from a donor after neurologic determination of death

You CAN'T join if...

  • Liver transplantation from a donor after cardiac death
  • Acute liver failure
  • Living-donor liver transplantation
  • Simultaneous liver-kidney transplantation
  • Preoperative renal replacement therapy
  • Preoperative intubation
  • Portopulmonary hypertension
  • Machine perfusion of liver graft


  • University of California, San Francisco accepting new patients
    San Francisco California 94143 United States
  • University of Colorado Anschutz Medical Campus accepting new patients
    Aurora Colorado 80045 United States

Lead Scientist at University of California Health

  • Michael P Bokoch, MD, PhD (ucsf)
    Associate Professor, Anesthesia, School of Medicine. Authored (or co-authored) 29 research publications. Research interests: liver transplant anesthesia · vascular anesthesia · acute kidney injury · molecular pharmacology · endothelium · coagulation · beta blockers · pupillometry · G-protein-coupled receptors


accepting new patients
Start Date
Completion Date
University of California, San Francisco
Study Type
Expecting 230 study participants
Last Updated