title: CYP2E1 immunoglobulin G4 subclass antibodies after desflurane anesthesia.
abstract: OBJECTIVE
  To investigate CYP2E1 IgG4 autoantibody levels and liver biochemical markers in adult patients after anesthesia with desflurane.
  
  
  METHODS
  Forty patients who were > 18 years old and undergoing elective surgery under general anesthesia with desflurane were studied. Alpha-glutathione-S-transferase (αGST) and IgG4 antibodies against CYP2E1 were measured preoperatively and 96 h postoperatively, as well as complete blood count, prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), aspartate aminotransferase (SGOT), alanine aminotransferase (SGPT), g-glutamyl-transpeptidase (gGT), alkaline phosphatase, total serum proteins, albumin and bilirubin. A separate group of 8 patients who received regional anesthesia was also studied for calibration of the methodology used for CYP2E1 IgG4 and αGST measurements. Student's t-test and the Mann-Whitney U test were used for comparison of the continuous variables, and Fisher's exact test was used for the categorical variables. All tests were two-tailed, with statistical significance set as P < 0.05.
  
  
  RESULTS
  None of the patients developed postoperative liver dysfunction, and all patients were successfully discharged from the hospital. No statistically significant difference was observed regarding liver function tests (SGOT, SGPT, γGT, bilirubin, INR), αGST and CYP2E1 IgG4, before and after exposure to desflurane. After dividing patients into two subgroups based on whether or not they had received general anesthesia in the past, no significant difference in the levels of CYP2E1 IgG4 was observed at baseline or 96 h after desflurane administration (P = 0.099 and P = 0.051, respectively). Alpha-GST baseline levels and levels after the intervention also did not differ significantly between these two subgroups (P > 0.1). The mean αGST differences were statistically elevated in men by 2.15 ng/mL compared to women when adjusted for BMI, duration of anesthesia, number of times anesthesia was administered previously and length of hospital stay. No significant difference was observed between patients who received desflurane and those who received regional anesthesia at any time point.
  
  
  CONCLUSIONS
  There was no difference in CYP2E1 IgG4 or αGST levels after desflurane exposure; further research is required to investigate their role in desflurane-induced liver injury.
authors.affiliation: Chrysanthi Batistaki, George Michalopoulos, Paraskevi Matsota, Konstantinos Kalimeris, Maria Riga, Maria Nakou, Georgia Kostopanagiotou, 2 Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" University Hospital, 12462 Athens, Greece.
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Batistaki
authors.affiliation: Chrysanthi Batistaki, George Michalopoulos, Paraskevi Matsota, Konstantinos Kalimeris, Maria Riga, Maria Nakou, Georgia Kostopanagiotou, 2 Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" University Hospital, 12462 Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Michalopoulos
authors.affiliation: Chrysanthi Batistaki, George Michalopoulos, Paraskevi Matsota, Konstantinos Kalimeris, Maria Riga, Maria Nakou, Georgia Kostopanagiotou, 2 Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" University Hospital, 12462 Athens, Greece.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Matsota
authors.affiliation: Chrysanthi Batistaki, George Michalopoulos, Paraskevi Matsota, Konstantinos Kalimeris, Maria Riga, Maria Nakou, Georgia Kostopanagiotou, 2 Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" University Hospital, 12462 Athens, Greece.
authors.forename: Tzortzis
authors.initials: T
authors.lastname: Nomikos
authors.affiliation: Chrysanthi Batistaki, George Michalopoulos, Paraskevi Matsota, Konstantinos Kalimeris, Maria Riga, Maria Nakou, Georgia Kostopanagiotou, 2 Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" University Hospital, 12462 Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kalimeris
authors.affiliation: Chrysanthi Batistaki, George Michalopoulos, Paraskevi Matsota, Konstantinos Kalimeris, Maria Riga, Maria Nakou, Georgia Kostopanagiotou, 2 Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" University Hospital, 12462 Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Riga
authors.affiliation: Chrysanthi Batistaki, George Michalopoulos, Paraskevi Matsota, Konstantinos Kalimeris, Maria Riga, Maria Nakou, Georgia Kostopanagiotou, 2 Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" University Hospital, 12462 Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Nakou
authors.affiliation: Chrysanthi Batistaki, George Michalopoulos, Paraskevi Matsota, Konstantinos Kalimeris, Maria Riga, Maria Nakou, Georgia Kostopanagiotou, 2 Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" University Hospital, 12462 Athens, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Kostopanagiotou
keywords: Anesthesia; CYP2E1 IgG4; Desflurane; Drug-induced-liver injury; Hepatotoxicity