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ENDOTOXIN LEVELS IN DONORS AND RECIPIENTS DURING ORTHOTOPIC LIVER TRANSPLANTATION
Author(s) -
Pillay S. P.,
Wynter C.,
Lynch S.,
Wall D.,
Balderson G.,
Strong R.
Publication year - 1997
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1997.tb01938.x
Subject(s) - medicine , limulus , liver transplantation , venous blood , transplantation , vein , dissection (medical) , portal vein , gastroenterology , surgery , urology , anesthesia , paleontology , biology
Background : The hypothesis being tested in this paper is that endotoxin levels in donors and in recipients during liver transplantation influences postoperative outcome. Methods : Endotoxin levels in systemic venous and portal venous blood were measured in 46 adult donors and 44 adult recipients (47 liver transplants) during the period 1992–95. Endotoxin was measured using a modification of the Limulus amoebocyte lysate (LAL) assay. Results : In the donor, systemic endotoxin levels were above normal levels at 10.0 ± 1.3 pg/mL from the start and rose to 15.8 ± 2.9 pg/mL after dissection of the hilar structures, but fell to 10.6 ± 0.8 pg/mL just prior to the removal of the liver (control = 7.8 pg/mL). The mean portal venous endotoxin levels were 18.2 ± 3.4 pg/mL after dissection of the hilar structures and 12.6 ± 0.9 pg/mL after cannulation of the portal vein. In the recipients, the highest level in the portal venous blood occurred at the end of the anhepatic phase (46.5 ± 6.7 pg/mL). The systemic venous samples in the recipients were elevated to start with, but fell rapidly to 19.3 ± 1.5 pg/mL 24 h postoperatively, and to 13.2 ± 1.0 pg/mL by day 7. The endotoxin concentrations were higher in recipients who developed complications. Conclusions : Endotoxin is elevated throughout the recipient transplantation procedure and up to 7 days postoperatively. High levels of endotoxin at induction, the anhepatic phase and at certain time points correlated with patients who developed postoperative complications.