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Minerva Anestesiologica 2019 May;85(5):494-504

DOI: 10.23736/S0375-9393.18.12890-2


language: English

Effects of liver ischemia-reperfusion injury on respiratory mechanics and driving pressure during orthotopic liver transplantation

Vito FANELLI 1, 2 , Andrea COSTAMAGNA 1, Fabio CAROSSO 2, Giuseppe ROTONDO 2, Emanuele E. PIVETTA 3, Angelo PANIO 1, Paola CAPPELLO 4, Anna T. MAZZEO 1, 2, Lorenzo DEL SORBO 5, Salvatore GRASSO 6, Luciana MASCIA 7, Luca BRAZZI 1, 2, Renato ROMAGNOLI 2, Mauro SALIZZONI 2, Marco V. RANIERI 8

1 Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy; 2 Department of Surgical Science, University of Turin, Turin, Italy; 3 Department of Medical Sciences, University of Turin, Turin, Italy; 4 Laboratory of Tumor Immunology, Experimental Medicine Research Center (CeRMS), University of Turin, Turin, Italy; 5 Division of Respirology and Critical Care Medicine, Department of Medicine, Toronto General Hospital, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada; 6 Unit of Anesthesia and Intensive Care, Department of Emergency Medicine and Organ Transplant (DETO), University of Bari, Bari, Italy; 7 Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy; 8 Department of Anesthesia and Intensive Care Medicine, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy

BACKGROUND: During orthotopic liver transplantation (OLT), liver graft ischemia-reperfusion injury (IRI) triggers a cytokine-mediated systemic inflammatory response, which impairs graft function and disrupts distal organ homeostasis. The objective of this prospective, observational trial was to assess the effects of IRI on lung and chest wall mechanics in the intraoperative period of patients undergoing OLT.
METHODS: In 26 patients undergoing OLT, we measured elastance of the respiratory system (ERS), partitioned into lung (EL) and chest wall (ECW), hemodynamics, and fluid and blood product intake before laparotomy (T1), after portal/caval surgical clamp (T2), and immediately (T3) and, at 90 and 180 minutes post-reperfusion (T4 and T5, respectively). Interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), IL-1β and tumor necrosis factor-α plasma concentrations were assessed at T1, T4 and T5.
RESULTS: EL significantly decreased from T1 to T2 (13.5±4.4 vs 9.7±4.8 cmH2O/L, P<0.05), remained stable at T3, while at T4 (12.3±4.4 cmH2O/L, P<0.05) was well above levels recorded at T2, reaching its highest value at T5 (15±3.9 cmH2O/L, P<0.05). Variations in ERS, EL, driving pressure (∆P) and trans-pulmonary pressure (∆PL) significantly correlated with changes in IL-6 and MCP-1 plasma concentrations, but not with changes in wedge pressure, fluid amounts, and red blood cells and platelets administered. No correlation was found between changes in cytokine concentrations and ECW.
CONCLUSIONS: We found that EL, ECW, ∆P and ∆PL underwent significant variations during the OLT procedure. Further, we documented a significant association between the respiratory mechanics changes and the inflammatory response following liver graft reperfusion.

KEY WORDS: Liver transplantation; Ischemia; Reperfusion injury; Cytokines; Respiratory mechanics

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