Factors predicting perioperative cytokine response in patients undergoing liver transplantation

Objectives: An exaggerated production of proinflammatory cytokines during l iver transplantation stimulates the inflammatory process within the graft, and eventually promotes liver failure. This study was conducted to evaluate factors predicting perioperative response of proinflammatory cytokines dur ing liver transplantation. Design: Prospective, consecutive entry study of liver transplant candidates . Setting: University hospital. Patients: Thirty liver transplant recipients. Interventions: Arterial blood samples were obtained perioperatively, Measurements: Interleukin (IL)-1 beta, IL-6, tumor necrosis factor-alpha we re measured by ELISA. Endotoxin was determined by a chromogenic endotoxin-s pecific method. Main Results: The peak concentrations of IL-1 beta and IL-6 in the patients with complications were significantly higher than those in the patients wi thout complications. The peak concentration of IL-1 beta was significantly correlated with the level of bilirubin at admission and the intraoperative blood product requirement. The peak concentration of IL-6 was significantly correlated with the admission bilirubin and the intraoperative blood produ ct requirement. A multivariate regression model revealed that the serum bil irubin and the intraoperative blood product requirement were the independen t factors that influenced the peak concentration of IL-1 beta or IL-6, The severely jaundiced patients had a significantly higher plasma concentration of endotoxin at the end of the anhepatic phase. In addition, there was a t endency for these patients to have a higher postoperative peak concentratio n of endotoxin, Conclusions: Serum level of bilirubin may be a potent preoperative factor i nfluencing perioperative cytokine response in patients undergoing liver tra nsplantation. An enhanced perioperative response of endotoxin seen in sever ely jaundiced patients suggests the clinical implication of endotoxin remov al during the anhepatic phase in liver transplant surgery.