Cytokine responses to cardiopulmonary bypass: lessons learned from cardiac transplantation.
BACKGROUND
A growing body of evidence relates the release during cardiopulmonary bypass (CPB) of proinflammatory cytokines, such as tumor necrosis factor-alpha, interleukin (IL)-6, and IL-8, to the postoperative systemic inflammatory response syndrome. Antiinflammatory cytokines, such as IL-10, however, may also play an important role in limiting these complications.


METHODS
The English-language literature was reviewed. Emphasis was placed on cytokine responses during clinical CPB for cardiac operations and, in particular, for heart and heart-lung transplantation.


RESULTS
The recent data indicate that (1) although cytokine release can be triggered by many factors during CPB, ischemia-reperfusion may play the most important role; (2) the levels of tumor necrosis factor-alpha, IL-6, and IL-8 are correlated with the duration of cardiac ischemia and the myocardium is a major source of these three cytokines during CPB; (3) IL-10 levels are correlated with the duration of CPB and the liver is a major source of IL-10 during CPB; and (4) steroid pretreatment is an effective intervention to inhibit the release of proinflammatory cytokines and enhance IL-10 production.


CONCLUSIONS
The improved knowledge of cytokine responses to CPB may help to develop interventions aimed at reducing postoperative morbidity and mortality.
Wan
S
S
Department of Cardiac Surgery, University Hospital Erasme, Free University of Brussels, Belgium.
LeClerc
J L
JL
Vincent
J L
JL
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002315:Cardiopulmonary Bypass; D003167:Complement Activation; D016207:Cytokines / Q000378:metabolism*; D016027:Heart Transplantation; D016041:Heart-Lung Transplantation; D006801:Humans; D016753:Interleukin-10 / Q000502:physiology; D008099:Liver / Q000378:metabolism; D015428:Myocardial Reperfusion Injury / Q000276:immunology; D009206:Myocardium / Q000378:metabolism; D011183:Postoperative Complications / Q000276:immunology*; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology*; D013696:Temperature
D000305:Adrenal Cortex Hormones; D016207:Cytokines; D016753:Interleukin-10