LEUKOCYTE ACTIVATION BY ISOLATED HYPERTHERMIC LIVER AND LIMB PERFUSION DUE TO MALIGNANCY

Fourteen patients with liver tumor malignancy and sixteen patients wit h malignant melanoma localized to one limb were studied regarding leuk ocyte activation with the release of polymorphonuclear neutrophilic (P MN) elastase and of neopterin and formation of cytokines (TNF-alpha an d IL-6) during the surgical treatment, Patients undergoing liver resec tion (n = 10), abdominal hysterectomy (n = 10), or hip replacement sur gery (n = 10) served as control groups. Isolated hyperthermic liver pe rfusion was performed with cytostatic-containing perfusate (melphalan and cisplatinum). Patients with recurrent malignant melanoma confined to one limb underwent isolated hyperthermic limb perfusion with cytost atic-containing perfusate (melphalan). Blood samples for determination of PMN elastase, neopterin, TNF-alpha, and IL-6 were drawn from the p atients preoperatively, 1 minute before the start of the perfusion, 60 and 120 minutes after the start of the perfusion, and 24 hours postop eratively. Samples from the perfusate were drawn 60 minutes after the start of the perfusion, High concentrations of plasma PMN elastase wer e found both in patients undergoing liver and limb perfusion and in pa tients undergoing liver resection surgery. Elevated concentrations of IL-6 were found in the patients undergoing liver perfusion and in pati ents undergoing liver resection. In none of the patients were there in creased concentrations of neopterin or TNF-alpha. The perfusate contai ned high concentrations of PMN elastase, neopterin, and IL-6. This stu dy also demonstrated that major surgery leads to elevated concentratio ns of PMN elastase and IL-6. An increase of PMN elastase and IL-6 was seen in response to perfusion and to surgical trauma.