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Aims: Postoperative pulmonary complications including acute lung injury (ALI) and acute respiratory distress syndrome have contributed to the mortality and morbidity of orthotopic liver transplantation (OLT) with unclear mechanisms. Mast cells (MCs) and polymorphonuclear neutrophils (PMNs) are the main inflammatory cells and participants in the process of ALI. The present study was designed to investigate the role of MCs and PMNs and their potential relation to ALI following OLT. Main Methods: Rat orthotopic autologous liver transplantation (OALT) model was designed to determine lung injury at different time points after liver reperfusion. We also evaluated the function of MCs and the effect of TNF-α and tryptase on ALI and PMN apoptosis in rats subjected to OALT. Histological scores and inflammatory factor levels as well as PMN apoptosis were measured. Key findings: Rats suffered from ALI after OALT, which was demonstrated with collapse of pulmonary architecture, pulmonary edema, and infiltration of inflammatory cells in alveolar and interstitial spaces, as well as increased levels of pro-inflammatory cytokines. ALI maximized at 8 h after OALT. However, PMN apoptosis lagged behind the pulmonary injury and maximized at 16 h after OALT, when the acute inflammation resolution initiated. MC stabilization, and tryptase and TNF-α inhibitors could significantly decrease the lung pathophysiologic scores accompanied with an increase in PMN apoptosis. Significance: ALI after OLT was associated with MC activation and PMN apoptosis. The ALI progression might be affected by delayed PMN apoptosis, which was related to MC activation. Induction of PMN apoptosis might alleviate ALI after OALT.

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ObjectiveA gap between clinical practice and evidence is common. The present multicentre study was designed to explore the actual postoperative fasting practice, including the instructed fasting time from the ward staff and the actual postoperative fasting time.DesignMulticentre survey.SettingFour tertiary hospitals in Shenzhen City, China.ParticipantsA total of 988 patients completed a survey on instructed and actual postoperative fasting.OutcomesAll patients received postoperative instructed fasting time from the ward staff. The median instructed fasting time for fluids from ward staff was 6 hours (IQR, 4–6 hours), and the median instructed fasting time for solid food was also 6 hours (IQR 5–6 hours) after surgery. The actual postoperative fasting time, including fluid and solid food intake, was significantly longer than the time recommended by the ward staff (both p<0.001).ResultsThe median time to postoperative first flatus (FFL) was 16.5 hours (IQR 8–25.5 hours), and the median time to postoperative first faeces (FFE) was 41 hours (IQR 25–57 hours). The fasting time was significantly shorter than the time to FFL and the time to FFE, regardless of surgery type or anaesthesia type (all p<0.001). Postoperative nausea and vomiting (PONV) occurred in 23.6% of patients. After surgery, 58.70% of patients reported thirst, and 47.47% reported hunger. No ileus occurred.ConclusionApproximately half of the patients reported thirst and hunger postoperatively. Patients initiated oral intake earlier than the time to FFL or FFE without increasing serious complications. This study may support the rationale for interventions targeting postoperative oral intake time in future studies.

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