Changes Of Plasma Level Of Tumor Necrotic Factor-alpha,Interleukin-6 And -8 During Orthotopic Liver Transplantation And Relation Between Those Cytokines And Postoperative Pulmonary Complications

Objective To measure the concentrations of tumor necrotic factor-alpha^ interleukin-6 and -8 during OLT and to investigate its relationship to those cytokines and postoperative pulmonary complications.Methods Twenty-two ASA III ~ IV patients with end-stage liver diseases were studied. Anesthesia was maintained with isoflurane inhalation combined with fentanyl , propofol and vecuronium iv. Veno-venous bypass was not used during the anhepatic stage. The patients were divided into two groups according to whether they had pulmonary complications following operation: Group A (n=8) patients with postoperative pulmonary complications; group B (n=14) patients without postoperative pulmonary complications. Blood samples were taken at the beginning of operation(T0), clamping and unclamping of theinferior caval and portal vein(T1,T2),90min and 3h after reperfusion(T3, T4) and 24h after operation(T5) for determination of serum TNF , IL-6 and IL-8. All the patients were carefully monitored by regular analysis of blood counts , chest radiographs , sputum cultures and arterial blood gases during the three days following operation.Results The patients in the group A were including six cases ALI and two cases pneumonia. The Pao2/Fio2 in the group A was lower than that in group B(P<0.05).The TNFcu IL-6 and IL-8 concentrations in two groups increased rapidly at T2 ,peaked at T3,after T3 it decreased rapidly until 24 h after operation. The TNFcu IL-6 and IL-8 concentrations in Group A were higher than those in group B at T2, T3, T4 (P<0.05) .Conclusion After unclamping of the inferior caval and portal vein , serum TNFcu IL-6 and IL-8 concentrations increased, which were proximal trigger for pulmonary injury following hepatic I/R.