TUMOR-NECROSIS-FACTOR-ALPHA AND INTERLEUKIN-6 - EARLY INDICATORS OF BACTERIAL-INFECTION AFTER HUMAN ORTHOTOPIC LIVER-TRANSPLANTATION

Objective. To see if it was possible to predict the development of inf ection after liver transplantation from concentrations of endotoxin, t umour necrosis factor-alpha (TNF-alpha), or interleukin-6 (IL-6) in pl asma. Design: Prospective open study. Setting: University hospital, Au stria. Subjects. 46 Consecutive patients who underwent liver transplan tation for end stage liver disease, 1989-90. Interventions: Samples of 4 ml blood were taken in endotoxin free tubes, and of 10 ml into hepa rinised tubes at the beginning of the operation, during hepatectomy, a t the beginning and end of the anhepatic phase, 10 minutes after reper fusion, and at the end of the operation. Main outcome measures: Correl ation between development of infections postoperatively and operative release of endotoxin, TNF-alpha, and IL-6. Results: There was no corre lation between development of postoperative infections and operative c oncentrations of endotoxin, and of TNF-alpha and IL-6 up to the end of the anhepatic phase. There was, however, a sixfold increase in TNF-al pha and IL-6 concentrations between the end of the anhepatic phase and the end of the operation in patients who subsequently developed infec tions (p = 0.01). Conclusion: The increase in the concentrations of th ese two cytokines in the blood after reperfusion of the transplanted l iver seems to predict the development of subsequent bacterial infectio n.