Relationship between circulating secretory immunoglobulin A levels and portal blood cytokine levels during major abdominal surgery.

OBJECTIVE

To investigate whether circulating secretory immunoglobulin A (S-IgA) levels correlate with cytokine and endotoxin levels in the systemic or portal circulation during major abdominal surgery.

METHODS

Twenty patients who underwent abdominal surgery for malignant carcinoma were included in this prospective study. Portal blood samples were taken for the measurement of cytokine and endotoxin levels during abdominal surgery. Systemic blood samples were simultaneously collected for the determination of cytokine, endotoxin, and S-IgA levels. After surgery, serum levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and S-IgA were measured on the 1st, 7th, and 14th, postoperative days.

RESULTS

Circulating S-IgA levels correlated with interleukin-6 levels (r = 0.48, P < .05), but not with interleukin-1 or endotoxin levels in the portal circulation. In the postoperative period, the best correlation between serum S-IgA and other biochemical parameters was found with alkaline phosphatase (r = 0.87, P < .01), followed by alanine aminotransferase (r = 0.70, P < .01).

CONCLUSIONS

Interleukin-6 in the portal blood might stimulate synthesis and/or regurgitation from bile into the systemic circulation of S-IgA. Circulating levels of S-IgA appeared as a sensitive marker for postoperative cholestatic liver damage.