title: Inflammatory markers sampled by microdialysis catheters distinguish rejection from ischemia in liver grafts.
abstract: Rejection and ischemia are serious complications after liver transplantation. Early detection is mandatory, but specific markers are largely missing, particularly for rejection. The objective of this study was to explore the ability of microdialysis catheters inserted in liver grafts to detect and discriminate rejection and ischemia through postoperative measurements of inflammatory mediators. Microdialysis catheters with a 100-kDa pore size were inserted into 73 transplants after reperfusion. After the study's completion, complement activation product 5a (C5a), C-X-C motif chemokine 8 (CXCL8), CXCL10, interleukin-1 (IL-1) receptor antagonist, IL-6, IL-10, and macrophage inflammatory protein 1β were analyzed en bloc in all grafts with biopsy-confirmed rejection (n = 12), in grafts with vascular occlusion/ischemia (n = 4), and in reference grafts with a normal postoperative course of circulating transaminase and bilirubin levels (n = 17). The inflammatory mediators were elevated immediately after graft reperfusion and decreased toward low, stable values during the first 24 hours in nonischemic grafts. In grafts suffering from rejection, CXCL10 increased significantly (P = 0.008 versus the reference group and P = 0.002 versus the ischemia group) 2 to 5 days before increases in circulating alanine aminotransferase and bilirubin levels. The area under the receiver operating characteristic curve was 0.81. Grafts with ischemia displayed increased levels of C5a (P = 0.002 versus the reference group and P = 0.008 versus the rejection group). The area under the curve was 0.99. IL-6 and CXCL8 increased with both ischemia and rejection. In conclusion, CXCL10 and C5a were found to be selective markers for rejection and ischemia, respectively.
authors: Division of Emergencies and Critical Care, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
authors: Håkon
authors: H
authors: Haugaa
authors: Ebbe Billmann
authors: EB
authors: Thorgersen
authors: Anne
authors: A
authors: Pharo
authors: Kirsten M
authors: KM
authors: Boberg
authors: Aksel
authors: A
authors: Foss
authors: Pål Dag
authors: PD
authors: Line
authors: Truls
authors: T
authors: Sanengen
authors: Runar
authors: R
authors: Almaas
authors: Guro
authors: G
authors: Grindheim
authors: Lars
authors: L
authors: Waelgaard
authors: Soeren Erik
authors: SE
authors: Pischke
authors: Tom Eirik
authors: TE
authors: Mollnes
authors: Tor
authors: T
authors: Inge Tønnessen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D057785:Catheters; D054357:Chemokine CXCL10 / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D015936:Complement C5a / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007223:Infant; D018836:Inflammation Mediators / Q000378:metabolism*; D007511:Ischemia / Q000175:diagnosis* / Q000276:immunology; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D017551:Microdialysis / Q000295:instrumentation*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; C114753:CXCL10 protein, human; D054357:Chemokine CXCL10; D018836:Inflammation Mediators; D015936:Complement C5a