Endotoxin levels in donors and recipients during orthotopic liver transplantation.
BACKGROUND
The hypothesis being tested in this paper is that endotoxin levels in donors and in recipients during liver transplantation influences postoperative outcome.


METHODS
Endotoxin levels in systemic venous and portal venous blood were measured using in 46 adult donors and 44 adult recipients (47 liver transplants) during the period 1992-95. Endotoxin was measured using a modification of the Limulus amoebocyte lysate (LAL) assay.


RESULTS
In the donor, systemic endotoxin levels were above normal levels at 10.0 +/- 1.3 pg/mL from the start and rose to 15.8 +/- 2.9 pg/mL after dissection of the hilar structures, but fell to 10.6 +/- 0.8 pg/mL just prior to the removal of the liver (control = 7.8 pg/mL). The mean portal venous endotoxin levels were 18.2 +/- 3.4 pg/mL after dissection of the hilar structures and 12.6 +/- 0.9 pg/mL after cannulation of the portal vein. In the recipients, the highest level in the portal venous blood occurred at the end of the anhepatic phase (46.5 +/- 6.7 pg/mL). The systemic venous samples in the recipients were elevated to start with, but fell rapidly to 19.3 +/- 1.5 pg/mL 24 h postoperatively, and to 13.2 +/- 1.0 pg/mL by day 7. The endotoxin concentrations were higher in recipients who developed complications.


CONCLUSIONS
Endotoxin is elevated throughout the recipient transplantation procedure and up to 7 days postoperatively. High levels of endotoxin at induction, the anhepatic phase and at certain time points correlated with patients who developed postoperative complications.
Pillay
S P
SP
Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Australia. P.Pillay@mailbox.uq.edu.au
Wynter
C
C
Lynch
S
S
Wall
D
D
Balderson
G
G
Strong
R
R
D000293:Adolescent; D000328:Adult; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D018805:Sepsis / Q000453:epidemiology; D014019:Tissue Donors; D016896:Treatment Outcome
D004731:Endotoxins