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Inflammatory markers sampled by microdialysis catheters distinguish rejection from ischemia in liver grafts
Author(s) -
Haugaa Håkon,
Thorgersen Ebbe Billmann,
Pharo Anne,
Boberg Kirsten M.,
Foss Aksel,
Line Pål Dag,
Sanengen Truls,
Almaas Runar,
Grindheim Guro,
Wælgaard Lars,
Pischke Soeren Erik,
Mollnes Tom Eirik,
Tønnessen Tor Inge
Publication year - 2012
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.23503
Subject(s) - microdialysis , medicine , liver transplantation , ischemia , graft rejection , pathology , surgery , transplantation , cardiology , central nervous system
Abstract 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 1β 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. © 2012 AASLD.

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