Effect of N-acetylcysteine administration on intraoperative plasma levels of interleukin-4 and interleukin-10 in liver transplant recipients.
We investigated whether intraoperative administration of N-acetylcysteine (NAC) in liver transplant recipients ameliorated their inflammatory responses by increasing intraoperative plasma levels of interleukin (IL)-4 and IL-10. This prospective, randomized, double-blind clinical trial included liver transplant recipients randomly assigned to the NAC-treated (n = 25) or the placebo (n = 25) group. The NAC-treated group received 100 mg/kg dissolved in 5% dextrose over 15 minutes during the anhepatic phase, followed by a continuous infusion of 50 mg/kg in 5% dextrose over the next 24 hours, whereas the placebo group received equal amounts of 5% dextrose solution during the same time. Peripheral blood samples were drawn in EDTA-containing tubes after induction of anesthesia (I-1); at 15 minutes into the anhepatic phase (I-2) prior to the administration of NAC or placebo; at 5 minutes before reperfusion (I-3); at 10 minutes after reperfusion (I-4); at 20 minutes after reperfusion (I-5); at 60 minutes after reperfusion (I-6); and at 1 hour after completion of the liver transplantation (I-7). Cytokine levels were determined using a technique which combined enzyme-linked immunosorbent assay (ELISA) and flow cytometry. Plasma IL-4 levels were significantly higher among the NAC-treated group than the placebo group at I-3 (P = .046) and I-4 (P = .041). Plasma IL-10 levels showed significant enhancement in the NAC-treated group at 5 minutes before reperfusion (I-3; P = .007). We concluded that intraoperative NAC administration during the anhepatic phase of liver transplantation significantly increased recipient IL-4 plasma levels before and after reperfusion, and IL-10 plasma values before reperfusion (I-3). These enhancements seemed to be associated with a protective effect against reperfusion injury.
Santiago
F M
FM
Anesthesiology Service, Virgen de las Nieves University Hospital, Granada, Spain.
Bueno
P
P
Olmedo
C
C
Muffak-Granero
K
K
Comino
A
A
Serradilla
M
M
Mansilla
A
A
Villar
J M
JM
Garrote
D
D
Ferrón
J A
JA
D000111:Acetylcysteine / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004311:Double-Blind Method; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D015847:Interleukin-4 / Q000097:blood*; D016031:Liver Transplantation / Q000502:physiology*; D016343:Monitoring, Intraoperative; D010919:Placebos; D011446:Prospective Studies
D000893:Anti-Inflammatory Agents; D010919:Placebos; D016753:Interleukin-10; D015847:Interleukin-4; D000111:Acetylcysteine