Enhanced polymorphonuclear neutrophil-mediated endothelial cell injury andits relation to high surgical mortality rate in cirrhotic patients

OBJECTIVE: A high incidence of complications has been documented in patient s with cirrhosis after operations. Recently, polymorphonuclear neuntrophils (PMN) have been revealed to have the capacity to injure vascular endotheli um and to cause organ damage. Furthermore, the altered function of PMN has been shown in patients with cirrhosis. However, there are few reports inves tigating the interaction between PMN and endothelial cells and its relation to a high incidence of postoperative complications in cirrhosis. The aim o f this study was to evaluate PMN-mediated endothelial cell injury in patien ts with cirrhosis. METHODS: Patients were divided into two groups: those who had normal liver with metastatic liver carcinoma and those who had cirrhosis with hepatocell ular carcinoma. All patients in both groups underwent hepatic resection. PM N were isolated from patients before operation. Human umbilical Vein endoth elial cells and PMN were cocultured after addition of phorbol myristate ace tate. The release of lactate dehydrogenase (LDH) and thrombomodulin in the cocultured medium and the elastase activity in PMN suspension were measured . RESULTS: The release of both LDH and thrombomodulin in the group with cirrh osis was significantly higher than in the group with normal liver. The elas tase activity was similarly higher in the group with cirrhosis than in the group with normal liver. The surgical morbidity rate was remarkably higher in the group with cirrhosis (50%) than in the group with normal liver (0%). CONCLUSIONS: This study shows that PMN have an enhanced potential to cause endothelial cell injury in patients with cirrhosis. This PMN "priming" may be responsible for the occurrence of postoperative complications in patient s with cirrhosis after hepatectomy. (C) 1999 by Am. Cell. of Gastroenterolo gy.