Energy storage and cytokine response in patients undergoing liver transplantation

Overproduction of pro-inflammatory cytokines during surgery has been known to exert tissue-damaging and lethal effects on the host. Hypermetabolism-as sociated malnutrition, a common feature of patients with end-stage liver di seases, is related to the presence of a systemic inflammatory response, as reflected by enhanced le,els of proinflammatory cytokines, The present stud y was designed to evaluate energy status of 29 Liver transplant recipients, and to assess the relation of energy storage to post-operative cytokine re sponse, The glycogen contents of the graft, and the recipient's abdominal m uscle and old liver were measured. The plasma concentrations of tumour necr osis factor alpha, interleukin 1 beta, interleukin 6, lactate, pyruvate and total ketone bodies were determined during and after surgery, In undernour ished patients, ketone bodies seemed to be the major fuel available to musc le, The concentration of ketone bodies decreased rapidly after the incision , and remained at a low level after reperfusion. These patients had higher plasma levels of lactate/pyruvate ratio and aromatic amino acids during the anhepatic phase, followed by an exaggerated response of cytokines. Depleti on of energy storage of the recipients may be involved in the deterioration of peri-operative energy metabolism and the exaggerated post-operative cyt okine response. (C) 1999 Academic Press.