Waelgaard Lars, Thorgersen Ebbe Billmann, Line Pål-Dag, Foss Aksel, Mollnes Tom Eirik, Tønnessen Tor Inge
Department of Anaesthesia and Critical Care Medicine, Rikshospitalet, University Hospital, University of Oslo, Oslo, Norway.
Transplantation. 2008 Oct 27;86(8):1096-103. doi: 10.1097/TP.0b013e31818775ca.
The outcome of liver transplantation is steadily improving. Still there is need for earlier detection of complications like hepatic artery thrombosis and rejection. The aim of this study was to explore whether microdialysis with a 100-kDa cutoff filter could be used to monitor local inflammation after liver transplantation.
Twenty patients undergoing liver transplantations were observed for 1 week posttransplant. Microdialysis catheters were introduced in each liver lobe subcutaneously and metabolic parameters (glucose, pyruvate, glycerol, and lactate), cytokines (interleukin [IL]-6, IL-8, monocyte chemottractic protein-1, and inducible protein [IP]-10), and complement activation (C5a) were measured.
Fourteen patients experienced an uneventful course, judged clinically by ultrasound Doppler and by metabolic markers including lactate and the ischemia indicator lactate-to-pyruvate ratio. All patients with uneventful course had a consistent rise in IP-10 from 200 to 3000 pg/mL after transplantation, whereas the other cytokines stayed low. Two patients with rejection showed a selective increase in IL-8 and C5a, starting 2 to 4 days before alanine transferase increased, reaching 10- to 50-fold increase compared with baseline levels, and decreased rapidly after start of antirejection therapy. C5a concentration was substantially increased in these two patients at the time of transplantation. A third patient developed a hepatic artery thrombosis and rejection and showed a rapid rise in intrahepatic lactate and a complex inflammatory pattern.
Microdialysis using a 100-kDa filter is a promising way of monitoring the inflammatory reaction after liver transplantation. Increase in IP-10 reflects a normal pathophysiologic response posttransplant, whereas IL-8 and C5a were increased only in patients with rejection.
肝移植的效果在稳步改善。然而，仍需要更早地检测诸如肝动脉血栓形成和排斥反应等并发症。本研究的目的是探讨使用截留分子量为100 kDa的滤器进行微透析是否可用于监测肝移植后的局部炎症。
对20例接受肝移植的患者在移植后观察1周。将微透析导管皮下插入每个肝叶，测量代谢参数（葡萄糖、丙酮酸、甘油和乳酸）、细胞因子（白细胞介素[IL]-6、IL-8、单核细胞趋化蛋白-1和诱导蛋白[IP]-10）以及补体激活产物（C5a）。
14例患者病情平稳，通过超声多普勒以及包括乳酸和缺血指标乳酸与丙酮酸比值在内的代谢标志物进行临床判断。所有病情平稳的患者移植后IP-10从200 pg/mL持续升至3000 pg/mL，而其他细胞因子水平保持较低。2例发生排斥反应的患者IL-8和C5a选择性升高，在丙氨酸转氨酶升高前2至4天开始，与基线水平相比升高了10至50倍，抗排斥治疗开始后迅速下降。这2例患者在移植时C5a浓度大幅升高。第3例患者发生肝动脉血栓形成和排斥反应，肝内乳酸迅速升高且呈现复杂的炎症模式。
使用截留分子量为100 kDa滤器的微透析是监测肝移植后炎症反应的一种有前景的方法。IP-10升高反映移植后的正常病理生理反应，而IL-8和C5a仅在发生排斥反应的患者中升高。
