Endotoxemia during liver transplantation

Stadlbauer, Vanessa; Davies, Nathan; Wright, Gavin; Mookerjee, Rajeshwar P.; Jalan, Rajiv

doi:10.1002/lt.21249

Cited by 2 publications

(1 citation statement)

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“…The importance of intestinal endotoxins as critical players in liver failure in situations of chronic or acute liver disease [7], liver transplants [8], major liver resection on healthy liver or minor resection on pathological liver [9] have been studying since the mid‐1970s. It appears that major alteration of the reticuloendothelial system in the cirrhotic patient induces a decrease in the liver's ability to metabolize circulating endotoxins [10], leading to a hepatocyte damage and systemic release of endotoxins responsible for extrahepatic manifestations related to hepatic failure [11].…”

Section: Introductionmentioning

confidence: 99%

Influence of Probiotics Administration Before Liver Resection in Patients with Liver Disease: A Randomized Controlled Trial

et al. 2021

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Background By inhibiting the growth of pathogenic bacteria and modulating the local intestinal immune system, probiotics may reduce bacterial translocation and systemic endotoxaemia, factors partially responsible for post‐operative complications following liver resection for hepatocellular carcinoma in patients with cirrhosis. Methods Patients with resectable hepatocellular carcinoma developed in the setting of chronic liver disease were prospectively divided into two equal‐sized groups: one receiving probiotic treatment 14 days prior to surgery and the other receiving placebo. The primary endpoint was the level of circulating endotoxins after hepatectomy. Secondary endpoints were systemic inflammation (inflammatory cytokine levels), post‐operative liver function and overall post‐operative complication rate. Results From May 2013 to December 2018, 64 patients were randomized, and 54 patients were included in the analysis, 27 in each arm. No significant change in endotoxin levels was observed over time in either group (P = 0.299). No difference between the groups in terms of post‐operative liver function and overall complication rates was observed. The only differences observed were significant increases in the levels of TNFalpha (P = 0.019) and interleukin 1‐b (P = 0.028) in the probiotic group in the post‐operative period. Conclusion Contrary to the modest data reported in the literature, the administration of probiotics before minor liver resection for hepatocellular carcinoma developed in the setting of compensated chronic liver disease does not seem to have an impact on circulating endotoxin levels or post‐operative complication rates. Trial registration Trial registration: NCT02021253.

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