INFLUENCE OF INTRAOPERATIVE BLOOD-LOSS ON PLASMA-LEVELS OF CYTOKINES AND ENDOTOXIN AND SUBSEQUENT GRAFT LIVER-FUNCTION

Background: Excessive blood transfusion during orthotopic liver transp lantation (OLT) is correlated with a lower graft survival rate. Experi mentally, excessive hemorrhage is associated with endotoxemia and rele ase of proinflammatory cytokines. Objectives: To measure the concentra tions of plasma endotoxin and proinflammatory cytokines during OLT and to investigate their relation to intraoperative blood loss and graft viability. Design and Setting: A prospective case series in a liver tr ansplantation center. Patients: Thirty patients who underwent OLT. Gro up 1 comprised 6 patients whose operative blood transfusion requiremen t was 10 U or more; group 2 comprised 24 patients whose operative bloo d transfusion requirement was less than 10 U. Interventions: The follo wing factors were measured in the plasma before and after OLT. interle ukin (IL)-1 beta, IL-6, tumor necrosis factor alpha, hepatocyte growth factor, endotoxin, hyaluronic acid, and lactate. Main Outcome Measure : Graft viability. Results: Two patients in group 1 died. All 24 patie nts in group 2 survived after they underwent OLT. The responses of IL- 6 and IL-1 beta in group 1 were striking compared with those ingroup 2 , and they were accompanied by an elevation of the endotoxin concentra tion and a subsequent elevation of the concentrations of hepatocyte gr owth factor, hyaluronic acid, lactate, and other factors that reflecte d graft viability. Conclusions: The changes in IL-6 seemed to respond to the excessive intraoperative hemorrhage, to provoke the elevation o f the endotoxin concentration, and to be associated with the graft via bility. The prevention of excessive intraoperative bleeding and the su bsequent response of proinflammatory cytokines may be contributing fac tors to the success of liver transplant surgery.