Isolated hyperthermic liver perfusion with cytostatic-containing perfusate activates the complement cascade.
Eight patients with advanced liver malignancy undergoing isolated hyperthermic liver perfusion with melphalan and cisplatin were studied with regard to complement activation and formation of anaphylatoxins (C3a and C5a) and terminal C5b-9 complement complexes (TCCs). Blood samples for complement variables (C1-INH, C3, C4, C5, C3a, C5a and TCCs) were taken before surgery, 1 min before the start of perfusion, 1, 2 and 3 h after the start of perfusion, and 24 h after operation. Samples were drawn from the perfusate 1 h after the start of perfusion. Activation of complement was observed during perfusion. Raised plasma concentrations of C3a and TCCs were recorded and high levels of C3a and TCCs were found in the perfusate. In vitro tests indicated that melphalan and cisplatin may activate complement. This activation occurred at 37 and 42 degrees C but was more pronounced at 42 degrees C.
Arnestad
J P
JP
Department of Anaesthesiology and Intensive Care, Sahlgren's Hospital, Gothenburg, Sweden.
Bengtsson
A
A
Bengtson
J P
JP
Henriksson
B A
BA
Stenqvist
O
O
Naredi
P
P
Hafström
L
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D010478:Chemotherapy, Cancer, Regional Perfusion; D002945:Cisplatin / Q000008:administration & dosage; D003167:Complement Activation / Q000276:immunology*; D015926:Complement C3a / Q000032:analysis; D015936:Complement C5a / Q000032:analysis; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008099:Liver / Q000276:immunology; D008113:Liver Neoplasms / Q000276:immunology* / Q000628:therapy; D008297:Male; D008558:Melphalan / Q000032:analysis; D008875:Middle Aged
D015926:Complement C3a; D015936:Complement C5a; D002945:Cisplatin; D008558:Melphalan