Early allograft dysfunction (EAD) is considered a precursor to graft loss in liver transplantation. To date, the use of preoperative serum cytokine profiles to predict EAD development has not been systematically investigated in living donor liver transplantation (LDLT). Here, we investigated the association between preoperative serum cytokine profiles and EAD development in LDLT patients.Serum cytokine profiles collected preoperatively and on postoperative day 7 were retrospectively reviewed. The specific serum cytokines analyzed included interleukin (IL)-2, IL-6, IL-10, IL-12, IL-17, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α. The cytokine levels of patients with EAD were compared with those of patients without EAD and the impact of cytokine levels on the occurrence of EAD was evaluated.Preoperatively, the serum levels of IL-6, 10, 17, and TNF-α were significantly higher in the EAD group than in the non-EAD group. In univariate logistic analysis, the preoperative levels of IL-6, IL-10, IL-17, IFN-γ, and TNF-α were potentially associated with EAD development. After multivariate logistic analysis, higher preoperative serum levels of IL-6 and 17 were significantly associated with EAD development. In addition, the incidence of EAD increased as the preoperative serum levels of IL-6 and IL-17 increased.Preoperative serum levels of IL-6 and IL-17 were significantly associated with EAD development in LDLT.
Background Early extubation after liver transplantation is safe and accelerates patient recovery. Patients with end-stage liver disease undergo sarcopenic changes, and sarcopenia is associated with postoperative morbidity and mortality. We investigated the impact of core muscle mass on the feasibility of immediate extubation in the operating room (OR) after living donor liver transplantation (LDLT). Methods A total of 295 male adult LDLT patients were retrospectively reviewed between January 2011 and December 2017. In total, 40 patients were excluded due to emergency surgery or severe encephalopathy. A total of 255 male LDLT patients were analyzed in this study. According to the OR extubation criteria, the study population was classified into immediate and conventional extubation groups (39.6 vs. 60.4%). Psoas muscle area was estimated using abdominal computed tomography and normalized by height squared (psoas muscle index [PMI]). Results There were no significant differences in OR extubation rates among the five attending transplant anesthesiologists. The preoperative PMI correlated with respiratory performance. The preoperative PMI was higher in the immediate extubation group than in the conventional extubation group. Potentially significant perioperative factors in the univariate analysis were entered into a multivariate analysis, in which preoperative PMI and intraoperative factors (i.e., continuous renal replacement therapy, significant post-reperfusion syndrome, and fresh frozen plasma transfusion) were associated with OR extubation. The duration of ventilator support and length of intensive care unit stay were shorter in the immediate extubation group than in the conventional extubation group, and the incidence of pneumonia and early allograft dysfunction were also lower in the immediate extubation group. Conclusions Our study could improve the accuracy of predictions concerning immediate post-transplant extubation in the OR by introducing preoperative PMI into predictive models for patients who underwent elective LDLT. Electronic supplementary material The online version of this article (10.1186/s12871-019-0781-z) contains supplementary material, which is available to authorized users.
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