Release of Cytokines and Hemodynamic Instability During the Reperfusion of a Liver Graft
Release of Cytokines and Hemodynamic Instability During the Reperfusion of a Liver Graft
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DOI：
10.1002/lt.22227
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发表时间：
2011-03-01
影响因子：
4.6
通讯作者：
Janicki, Piotr K.
中科院分区：
文献类型：
--
作者：
Bezinover, Dmitri;Kadry, Zakiyah;Janicki, Piotr K.
这项前瞻性观察性研究的目的是(1)确定移植肝在再灌流时是否将促炎细胞因子释放到体循环中，(2)确定它们是否对移植肝再灌流后观察到的任何随后的血流动力学不稳定起作用(如果发生这种释放)。对连续17例肝移植患者的血样进行了细胞因子分析，包括肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、IL-2、IL-6和IL-8。血样取自桡动脉、门静脉和冲洗血(取自放置在肝下腔静脉夹上方的导管)。将移植血管再灌注期间维持平均动脉压在65至75 mm Hg之间所需的儿茶酚胺的量与细胞因子水平进行比较。统计分析采用最小二乘法、Kendall‘s tau-b检验和回归分析。我们证明了来自肝移植物的冲洗血中含有大量和各种各样的细胞因子。其中大部分是通过嫁接灌溉去除的。肝灌洗结束时血标本中肿瘤坏死因子-α的浓度显著高于再灌流前的桡动脉(P=0.0067)和门静脉(P=0.0003)。这与用于治疗血流动力学不稳定的儿茶酚胺的量直接相关。虽然冲洗血中IL-1β、IL-2和IL-8的水平升高，但这些细胞因子的水平与儿茶酚胺的使用量之间没有统计学意义的相关性。《肝脏移植》17：324-330,2011。(C)2011年AASLD。
The objectives of this prospective, observational study were (1) to determine whether a transplanted liver graft releases proinflammatory cytokines into the systemic circulation upon reperfusion and (2) to determine whether they contribute to any subsequent hemodynamic instability observed after graft reperfusion (if this release occurs). Blood samples from 17 consecutive patients undergoing liver transplantation were analyzed for cytokines, including tumor necrosis factor alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), IL-2, IL-6, and IL-8. Blood samples were obtained from the radial artery, portal vein, and flush blood (a sample taken from a catheter placed above the infrahepatic inferior vena cava clamp). The amount of catecholamines necessary to maintain a mean arterial pressure between 65 and 75 mm Hg during graft reperfusion was compared with the level of cytokines. A statistical analysis was performed with the least squares method, Kendall's tau-b test, and regression analysis. We demonstrated that flush blood from the liver grafts contained a significant amount and variety of cytokines. Most of these were removed by graft irrigation. The concentration of TNF-alpha in samples obtained from flush blood at the end of liver irrigation was significantly higher than the concentration in samples obtained from the radial artery (P = 0.0067) or portal vein (P = 0.0003) before reperfusion. This correlated directly with the amount of catecholamines used to treat hemodynamic instability. Although there were increased levels of IL-1 beta, IL-2, and IL-8 in the flush blood, there was no statistically significant correlation between the levels of these cytokines and the amount of catecholamines used. Liver Transpl 17:324-330, 2011. (C) 2011 AASLD.