title: The role of portal vein clamping for cytokine release and neutrophils activity during liver resection and transplant.
abstract: OBJECTIVE
  Uncontrolled release of cytokines has been linked to graft dysfunction or rejection and contributes to an increase in mortality and morbidity. We argue that temporary vascular clamping of the hepatic pedicle during major hepatic surgery is a potential stimulus for an excessive release of cytokines and the activity of neutrophils.
  
  
  METHODS
  Thirty patients underwent partial liver resection or transplant. Samples were drawn preoperatively, immediately before portal vein clamping, at the early reperfusion period, and on days 1, 3, 5, and 7 after the operation. Central venous plasma concentrations of IL-6, IL-8, and TNF- a were compared to portal venous plasma. The influence of neutrophils on metabolic activity was measured by flow cytometry.
  
  
  RESULTS
  In both patient groups, no significant differences in cytokine concentrations between central and portal venous plasma were found. However, significant differences of neutrophils activity were observed in patients undergoing partial liver resection compared to patients after transplant.
  
  
  CONCLUSIONS
  Portal vein stasis induced by clamping the hepatic pedicle has no influence on the local release of IL-6, IL-8, and TNF-a. However, preoperatively increased plasma levels of TNF-a play a decisive role in the metabolic activity of neutrophils in patients with final-stage liver disease.
authors.affiliation: Department of Anaesthesiology, Hannover Medical School, 30625 Hannover, Germany. studzinki.arthur@mh-hannover.de
authors.forename: Arthur
authors.initials: A
authors.lastname: Studzinski
authors.forename: Dirk
authors.initials: D
authors.lastname: Scheinichen
authors.forename: Katja
authors.initials: K
authors.lastname: Stenger
authors.forename: Annette
authors.initials: A
authors.lastname: Weissig
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.forename: Bjoern
authors.initials: B
authors.lastname: Juettner