Association between Early Acute Respiratory Distress Syndrome after Living-Donor Liver Transplantation and Perioperative Serum Biomarkers: The Role of Club Cell Protein 16

Abstract

Background. Acute respiratory distress syndrome (ARDS) after living-donor liver transplantation (LDLT) is not uncommon, but it lacks the biomarkers for early detection. Club cell protein 16 (CC16), high-motility group box 1 protein (HMGB1), interleukin-1β (IL-1β), and IL-10 have been reported as relevant to the development of ARDS. However, they have not been investigated during LDLT. Methods. Seventy-three consecutive recipients undergoing LDLT were enrolled and received the same perioperative care plan. Perioperative serum CC16, HMGB1, IL-1β, and IL-10 levels were measured at the pretransplant state, 30 minutes after reperfusion, postoperative day 1 (POD1), and POD3. ARDS was diagnosed according to the 2012 Berlin definition. Results. Of the 73 recipients, 13 developed ARDS with significantly longer durations of mechanical ventilation and intensive care unit stay. Serum CC16 levels on POD1 increased significantly from the pretransplant state in the ARDS group but not in the non-ARDS group. Pretransplant serum CC16 levels were also higher in the ARDS group. The area under the receiver operating characteristic curves for POD1 serum CC16 levels used to discriminate ARDS was 0.803 (95% confidence interval: 0.679 to 0.895; p < 0.001). By comparison, HMGB1, IL-1β, and IL-10 were not associated with ARDS after LDLT. Conclusion. The higher pretransplant serum CC16 level and its increased level on POD1 were associated with the development of early ARDS after LDLT. This trial is registered with NCT01936545, 27 August 2013.

Lung-Protective Effects of Lidocaine Infusion on Patients with Intermediate/ High Risk of Postoperative Pulmonary Complications: A Double-Blind Randomized Controlled Trial

“…According to previous studies, postoperative plasma levels of CC–16 in patients undergoing abdominal surgery was 17.8 ng mL −1 , the standard deviation was 9.4. 5 , 20 Assuming that intravenous infusion of lidocaine can reduce CC-16 by 30%, 53 patients in each group can provide 80% power with a significance level of 0.05. We planned to recruit 62 patients in each group to compensate for 15% dropouts.…”

Volume Incentive Spirometry Reduces Pulmonary Complications in Patients After Open Abdominal Surgery: A Randomized Clinical Trial

“… 21 In addition, older age was associated with a higher risk of PPCs and poor survival rates since they are at an increased risk of comorbid conditions. 22 Congestive heart failure, a diagnosis of chronic obstructive pulmonary disease, an ASA score of II or higher, or chronic liver disease were independent risk factors for PPCs. 5 , 23–25 Kaw et al showed that patients with obstructive sleep apnoea have a two-fold increase in the risk of developing acute respiratory failure after non-cardiac surgery.…”

Construction and validation of a pulmonary complication score for patients after liver transplantation

“…8 Acho et al retrospectively analyzed 279 patients with LT, which revealed that immediate postoperative extubation could decrease pulmonary complications in LT patients. 9 Several biomarkers can be used for prognoses, such as Club Cell Protein 16 (CC16) level and connexin43 (Cx43) function before transplantation, which are related to the occurrence of early ARDS following LT. 10,11 However, no risk factors have been identified that can predict pulmonary complications in LT patients.…”

“…However, the participants in these studies had a variety of risk factors, making predicting pulmonary complications in actual practice problematic. At present, most studies on biomarkers require specific biological samples for patients, such as bronchoalveolar lavage fluid and lung tissues, which increases the difficulty of prediction, and the results may still require the integration of other clinical data 10,11,13,14 . Therefore, a simple, low‐cost, and highly available prediction method should be proposed to allow for the prediction of lung complications in LT patients more practical.…”

“…Meanwhile, Huang studied that diabetes mellitus prior to LT, preoperative impaired renal function, pre-operative ventilator and pre-operative molecular adsorbent recycling system (MARS) were risk factors for predicting postoperative respiratory failure after LT 1. However, none of the aforementioned risk variables were supported by our investigation, and there is no mechanism in place to forecast preoperative pulmonary problems following liver transplantation.Certain biomarkers, such as SERPINB1, Toll-Like Receptor 4, antagonist (MK-571) and Club Cell Protein 16 (CCP-16), were found to predict pulmonary complications and lung injury after LT 10,[13][14][15]. All of these indicators were still in the early stages of fundamental research and were not supported by a sizable body of clinical evidence, which is complex and costly at the same time, indicating that the outcome of risk variables was challenging to ascertain clinically.…”