Influence of Intraoperative Blood Loss on Plasma Levels of Cytokines and Endotoxin and Subsequent Graft Liver Function

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Abstract
Background: Excessive blood transfusion during orthotopic liver transplantation (OLT) is correlated with a lower graft survival rate. Experimentally, excessive hemorrhage is associated with endotoxemia and release of pro-inflammatory cytokines. Objectives: To measure the concentrations of plasma endotoxin and proinflammatory cytokines during OLT and to investigate their relation to intraoperative blood loss and graft viability. Design and Setting: A prospective case series in a liver transplantation center. Patients: Thirty patients who underwent OLT. Group 1 comprised 6 patients whose operative blood transfusion requirement was 10 U or more; group 2 comprised 24 patients whose operative blood transfusion requirement was less than 10 U. Interventions: The following factors were measured in the plasma before and after OLT: interleukin (IL)–1β, IL-6, tumor necrosis factor α, hepatocyte growth factor, endotoxin, hyaluronic acid, and lactate. Main Outcome Measure: Graft viability. Results: Two patients in group 1 died. All 24 patients in group 2 survived after they underwent OLT. The responses of IL-6 and IL-1 β in group 1 were striking compared with those in group 2, and they were accompanied by an elevation of the endotoxin concentration and a subsequent elevation of the concentrations of hepatocyte growth factor, hyaluronic acid, lactate, and other factors that reflected graft viability. Conclusions: The changes in IL-6 seemed to respond to the excessive intraoperative hemorrhage, to provoke the elevation of the endotoxin concentration, and to be associated with the graft viability. The prevention of excessive intraoperative bleeding and the subsequent response of proinflammatory cytokines may be contributing factors to the success of liver transplant surgery. Arch Surg. 1997;132:136-141