Endotoxins and cytokines during liver transplantation: Changes in plasma levels and effects on clinical outcome

Endotoxins, tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), and IL-6 are believed to have a key role in liver transplantation, The orig in and course of these factors is not completely known. In this prospective study of 40 patients, we sought more understanding of the relations betwee n these factors and their effects on clinical outcome by sampling at differ ent sites. Endotoxemia was only present in 20% of the patients, In 75% of t hese patients, it was present during the anhepatic phase and quickly resolv ed after reperfusion, Endotoxemia was not related to a clinical adverse eve nt, TNF-alpha was released from the graft after reperfusion, and initial le vels after reperfusion were related to predonation levels in the donor. Onl y levels of TNF-alpha in the recipient before transplantation were found to be predictive of postoperative complications, We conclude that monitoring endotoxins and these cytokines is of very limited value in predicting outco me.