Interleukin-6 and tumor necrosis factor-alpha levels following hepatic cryotherapy: Association with volume and duration of freezing

Although morbidity following cryotherapy is usually minor, a syndrome of mu ltiorgan failure and disseminated intravascular coagulation (DIC) has been described and referred to as the cryoshock phenomenon. We hypothesized that mediators similar to those in septic shock may be involved in this syndrom e. In this study we aimed to assess the plasma concentrations of the cytoki nes tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) follow ing hepatic cryotherapy and to relate them to the duration and volume of fr eezing and to hepatocellular injury. Between April and December 1997 blood samples were taken preoperatively and at different times postoperatively fr om patients undergoing hepatic artery catheter-insertion (HAC) (n = Ij), cr yotherapy (n = 5), liver resection (n = 9), liver resection and edge cryoth erapy (n = 7), or liver resection and cryotherapy of additional lesions (rt = 9). They were analyzed for serum aspartate transaminase (AST) and plasma TNF-alpha and IL-6 levels. There was a significant association (Pearson co rrelation) of serum AST levels 1 hour postoperatively,vith plasma TNF-alpha and IL-6 levels at the end of the procedure. In patients undergoing cryoth erapy or resection with cryotherapy of additional lesions (n = 14), the vol ume and duration of hepatic freezing were significantly associated with pos toperative serum AST and plasma TNF-alpha and IL-6 levels at various postop erative times. Hepatic cryotherapy is followed by cytokine release, with po stoperative plasma TNF-alpha and IL-6 levels associated with the degree of hepatic cryotrauma. These mediators may be involved in the occurrence of cr yoshock following large-volume hepatic freezing.