Inflammatory markers sampled by microdialysis catheters distinguish rejection from ischemia in liver grafts
Inflammatory markers sampled by microdialysis catheters distinguish rejection from ischemia in liver grafts
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DOI：
10.1002/lt.23503
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发表时间：
2012-12-01
影响因子：
4.6
通讯作者：
Tonnessen, Tor Inge
中科院分区：
文献类型：
--
作者：
Haugaa, Hakon;Thorgersen, Ebbe Billmann;Tonnessen, Tor Inge
排斥反应和缺血是肝移植后的严重并发症。早期检测是强制性的，但特异性标记物很大程度上缺失，特别是对于排斥反应。本研究的目的是探讨插入肝移植物中的微透析导管通过术后测量炎症介质来检测和区分排斥和缺血的能力。再灌注后，将孔径为 100 kDa 的微透析导管插入 73 个移植物中。研究完成后，对所有经活检证实排斥的移植物（n = 12）和血管闭塞/缺血的移植物（n = 4），以及术后循环转氨酶和胆红素水平正常的参考移植物（n = 17）。在非缺血性移植物中，炎症介质在移植物再灌注后立即升高，并在最初 24 小时内降至稳定的低值。在遭受排斥反应的移植物中，CXCL10 在循环丙氨酸转氨酶和胆红素水平增加前 2 至 5 天显着增加（与参考组相比，P = 0.008，与缺血组相比，P = 0.002）。受试者工作特征曲线下面积为 0.81。缺血的移植物显示 C5a 水平升高（与参考组相比 P = 0.002，与排斥组相比 P = 0.008）。曲线下面积为0.99。 IL-6 和 CXCL8 随缺血和排斥反应而增加。总之，CXCL10 和 C5a 被发现分别是排斥反应和缺血的选择性标记物。肝移植，2012。(c) 2012 AASLD。
Rejection and ischemia are serious complications after liver transplantation. Early detection is mandatory, but specific markers are largely missing, particularly for rejection. The objective of this study was to explore the ability of microdialysis catheters inserted in liver grafts to detect and discriminate rejection and ischemia through postoperative measurements of inflammatory mediators. Microdialysis catheters with a 100-kDa pore size were inserted into 73 transplants after reperfusion. After the study's completion, complement activation product 5a (C5a), C-X-C motif chemokine 8 (CXCL8), CXCL10, interleukin-1 (IL-1) receptor antagonist, IL-6, IL-10, and macrophage inflammatory protein 1 beta were analyzed en bloc in all grafts with biopsy-confirmed rejection (n = 12), in grafts with vascular occlusion/ischemia (n = 4), and in reference grafts with a normal postoperative course of circulating transaminase and bilirubin levels (n = 17). The inflammatory mediators were elevated immediately after graft reperfusion and decreased toward low, stable values during the first 24 hours in nonischemic grafts. In grafts suffering from rejection, CXCL10 increased significantly (P = 0.008 versus the reference group and P = 0.002 versus the ischemia group) 2 to 5 days before increases in circulating alanine aminotransferase and bilirubin levels. The area under the receiver operating characteristic curve was 0.81. Grafts with ischemia displayed increased levels of C5a (P = 0.002 versus the reference group and P = 0.008 versus the rejection group). The area under the curve was 0.99. IL-6 and CXCL8 increased with both ischemia and rejection. In conclusion, CXCL10 and C5a were found to be selective markers for rejection and ischemia, respectively. Liver Transpl, 2012. (c) 2012 AASLD.