Perioperative cytokines during orthotopic liver transplantation without venovenous bypass

Faybik, Peter; Hetz, Hubert; Krenn, C.-G.; Baker, Alfred L.; Berlakovich, Gabriela; Steltzer, H.

doi:10.1016/j.transproceed.2003.10.006

Cited by 13 publications

(7 citation statements)

References 8 publications

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“…During this phase, cytokines, metabolites, and other toxins accumulate in the splanchnic system. Previous studies addressing the topic of serum cytokine levels during LT have shown the anhepatic phase to mark the start of a sharp increase in the recipient serum interleukin‐6 (IL‐6) level to over 100 times the levels measured in control patients . Experimental studies have indicated deteriorated ischemia/reperfusion injury with an increased transcription rate of cytokines such as IL‐6, IL‐10, tumor necrosis factor, transforming factor, and macrophage inflammatory protein 1 in liver tissue samples.…”

Section: Discussionmentioning

confidence: 99%

“…Superiority of Tenofovir has been also described in post‐LT cohorts and non‐LT cohorts . Once the occurrence of HBV is confirmed and considering that spontaneous resolution is unlikely , the treatment should be initiated to prevent graft damage. Although some centers opt to treat post‐transplant HBV infection only when LFTs are elevated , we have chosen to treat HBV DNA positivity, achieving an excellent adjusted graft survival after 10 years, with no significant difference to grafts without HBV infection.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Inferior graft survival of hepatitis B core positive grafts is not influenced by post-transplant hepatitis B infection in liver recipients-A 35-year single-center experience

et al. 2016

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SUMMARYNonoptimal liver grafts, and among them organs from anti-HBc+ donors, are increasingly used for liver transplantation. In this retrospective study including 1065 adult liver transplantations performed between 1977 and 2012, we analyzed long-term patient and graft survival and occurrence of HBV infection. A total of 52 (5.1%) patients received an anti-HBc+ graft. The 10-year graft and patient survival of these recipients were 50.9% and 59.0% compared to 72.0% and 76.5% (P = 0.001; P = 0.004) of patients receiving anti-HBc-grafts, respectively. Cox regression model showed that high urgency allocation (P = 0.003), recipient age (P = 0.027), anti-HCV+ recipients (P = 0.005), and anti-HBc+ organs (P = 0.048) are associated with decreased graft survival. Thirteen of 52 (25.0%) patients receiving anti-HBc+ grafts developed post-transplant HBV infection within a mean of 2.8 years. In this study, antiviral prophylaxis did not have significant impact on HBV infection, but long-term survival (P = 0.008). Development of post-transplant HBV infection did not affect adjusted 10-year graft survival (100% vs. 100%; P = 1). Anti-HBc+ liver grafts can be transplanted with reasonable but inferior long-term patient and graft survival. The inferior graft survival is not, however, related with post-transplant HBV infection as long as early diagnosis and treatment take place.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Inferior graft survival of hepatitis B core positive grafts is not influenced by post-transplant hepatitis B infection in liver recipients-A 35-year single-center experience

et al. 2016

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“…During this phase, cytokines, metabolites, and other toxins accumulate in the splanchnic system. Previous studies addressing the topic of serum cytokine levels during liver transplantation have shown the anhepatic phase to mark the start of a sharp increase in the recipient serum interleukin‐6 (IL‐6) level to over 100 times the levels measured in control patients 14–16. Experimental studies have indicated deteriorated ischemia/reperfusion injury with an increased transcription rate of cytokines such as IL‐6, IL‐10, tumor necrosis factor α, transforming growth factor β, and macrophage inflammatory protein 1α in liver tissue samples.…”

Section: Discussionmentioning

confidence: 99%

The clinical relevance of the anhepatic phase during liver transplantation

et al. 2009

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This study assesses the relation between the anhepatic phase duration and the outcome after liver transplantation. Of 645 patients who underwent transplantation between 1994 and 2006, 194 were recipients of consecutive adult primary piggyback liver transplants using heart-beating donors. The anhepatic phase was defined as the time from the physical removal of the liver from the recipient to recirculation of the graft. Other noted study variables were the cold and warm ischemia times, donor and recipient age, donor and recipient body mass index, perioperative red blood cell (RBC) transfusion, indication for transplantation, and Model for End-Stage Liver Disease score. The primary outcome parameter was graft dysfunction, which was defined as either primary nonfunction or initial poor function according to the Ploeg-Maring criteria. The median anhepatic phase was 71 minutes (37-321 minutes). Graft dysfunction occurred in 27 patients (14%). Logistic regression analysis showed an anhepatic phase over 100 minutes [odds ratio (OR), 4.28], a recipient body mass index over 25 kg/m 2 (OR, 3.21), and perioperative RBC transfusion (OR, 3.04) to be independently significant predictive factors for graft dysfunction. One-year patient survival in patients with graft dysfunction was 67% versus 92% in patients without graft dysfunction (P Ͻ 0.001). A direct relation between the anhepatic phase duration and patient survival could, however, not be established. In conclusion, this study shows that liver transplant patients with an anhepatic phase over 100 minutes have a higher incidence of graft dysfunction. The shortage of donor organs, in combination with an increasing number of patients on the waiting list for transplantation, urges professionals involved in liver transplantation to strive for optimal utilization of liver grafts. An important issue in this process is minimizing the amount of damage induced during the cold ischemia time (CIT), warm ischemia time (WIT), and reperfusion, which are indissolubly connected to transplantation of a liver graft.Immediately after procurement of the liver of a deceased donor, cold storage is used to minimize ischemic injury. This cold ischemia phase usually lasts for several hours and ends the moment that the graft is taken from ice for implantation. Additionally, during the subsequent warm ischemia phase, the graft is extremely susceptible to ischemic injury. 1 The influence of the length of both CIT and WIT on the outcome of liver transplantation has been extensively studied.1-3 Recent studies even show a cumulative negative effect induced by prolonged CIT and WIT. 2,4 The length of the CIT is mainly determined by logistic factors, such as the distance and availability of operation facilities and personnel. The length of the WIT is less variable. It is mainly dependent on the quality and configuration of the recipient vessels and to a lesser extent the experience of the surgeon.The influence of the length of the anhepatic phase on the outcome of transplantation is less well studied. The ...

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“…The serum IL-6 levels in the recipient have been shown to offer a marker of hemodynamic performance during liver transplantation (Arranz et al 2003). Previous studies of serum cytokine levels during liver transplantation have shown that the anhepatic phase to marks the start of a sharp increase in the recipient serum IL-6 level to over 100 times the levels measured in control patients (Faybik et al 2003;Santiago et al 2006;Eleftheriadis et al 2014). IL-6 elevation has recently been reported to be associated with the production of mtDAMPs in a rat model (Ijtsma et al 2009).…”

Section: Discussionmentioning

confidence: 99%

Elevated Plasma Levels of Mitochondria-Derived Damage-Associated Molecular Patterns during Liver Transplantation: Predictors for Postoperative Multi-Organ Dysfunction Syndrome

Nagakawa

Soyama

Hidaka

et al. 2020

Tohoku J. Exp. Med.

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The systemic cytokine response during surgery has been reported to be stimulated by the molecules released from damaged cells, called damage-associated molecular patterns (DAMPs). The relationship between DAMPs and liver transplantation has not been reported. We aimed to clarify the relationship between the plasma levels of DAMPs and the short-term post-transplant outcomes, including mortality and postoperative multi-organ dysfunction syndrome (MODS). This retrospective cohort study enrolled 61 patients who underwent liver transplantation. Mitochondrial DNA fragments, as mitochondria-derived DAMPs (mtDAMPs), were isolated from frozen plasma obtained at the start and the end of transplantation and were quantified by polymerase chain reaction. The short-term post-transplant outcomes were compared among the groups categorized based on the median value of the intraoperative fluctuation of mtDAMPs levels. The mtDAMPs levels were increased from the start to the end of transplantation in 52 recipients (85.2%, n = 61). Regarding mortality, no significant differences were noted between the high group (n = 30) and the low group (n = 31). The higher plasma levels of mtDAMPs were correlated with the longer duration of postoperative vasopressor support (P < 0.05). Importantly, the rate of MODS on postoperative day 1 was significantly higher in the high group (high vs. low group: 21 patients [70%] vs. 11 patients [35.1%], P < 0.01). In conclusion, mtDAMPs were increased in plasma during liver transplantation in most recipients. This elevation was not associated with mortality, but associated with the post-transplant recovery. Measuring plasma mtDAMPs may be helpful for predicting posttransplant recovery among livertransplant recipients.

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Perioperative cytokines during orthotopic liver transplantation without venovenous bypass

Cited by 13 publications

References 8 publications

Inferior graft survival of hepatitis B core positive grafts is not influenced by post-transplant hepatitis B infection in liver recipients-A 35-year single-center experience

Inferior graft survival of hepatitis B core positive grafts is not influenced by post-transplant hepatitis B infection in liver recipients-A 35-year single-center experience

The clinical relevance of the anhepatic phase during liver transplantation

Elevated Plasma Levels of Mitochondria-Derived Damage-Associated Molecular Patterns during Liver Transplantation: Predictors for Postoperative Multi-Organ Dysfunction Syndrome

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