title: Impact of cytokine release on ventricular function after hepatic reperfusion: a prospective observational echocardiographic study with tissue Doppler imaging.
abstract: BACKGROUND
  Postreperfusion syndrome and haemodynamic instability are predictors for poor outcome after liver transplantation. Cytokine release has been claimed to be responsible for postreperfusion syndrome. However, the underlying pathophysiologic mechanism is not clarified. The aim of this prospective observational study was to correlate cardiac performance (measured by transoesophageal echocardiography (TEE), Doppler and Tissue Doppler Imaging (TDI)) to plasmatic cytokines: IL-6, IL-8, CXCL1, TGF-β and CD40L at 5 different time points during liver transplantation.
  
  
  METHODS
  Seventeen consecutive patients scheduled for orthotopic liver transplantation, age 18 to 75 years without contraindication for transoesophageal echocardiography were included. Patients were monitored with TEE and TDI. Systolic and diastolic cardiac function, MAP, MPAP, CVP, PCWP, CO and blood samples for cytokine assays were recorded or collected after induction, 15 min after vena cava inferior clamping, 2 to 5 min after reperfusion, 60 min after reperfusion and at the end of surgery.
  
  
  RESULTS
  Mean arterial pressure and catecholamine requirements remained unchanged, MPAP, CVP and CO increased, SVR decreased after unclamping. Postreperfusion syndrome did not develop. The haemodynamic parameters and the variations of TEE parameters were consistent with the volume load changes during clamping and declamping and did not reveal systolic or diastolic cardiac dysfunction. All cytokines, except TGF-β, increased.
  
  
  CONCLUSIONS
  These findings suggest, that significant cytokine release during liver transplantation is not necessarily coincident with haemodynamic instability and impaired cardiac function.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT00547924.
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zürich, Raemistrasse 100, 8091, Zürich, Switzerland. marco.zalunardo@usz.ch.
authors.forename: Marco P
authors.initials: MP
authors.lastname: Zalunardo
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zürich, Raemistrasse 100, 8091, Zürich, Switzerland. martin.schlaepfer@uzh.ch.|Institute of Physiology, University Zurich Irchel, 8057, Zurich, Switzerland. martin.schlaepfer@uzh.ch.
authors.forename: Martin
authors.initials: M
authors.lastname: Schläpfer
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zürich, Raemistrasse 100, 8091, Zürich, Switzerland. beatrice.beckschimmer@uzh.ch.|Institute of Physiology, University Zurich Irchel, 8057, Zurich, Switzerland. beatrice.beckschimmer@uzh.ch.|Department of Anesthesiologoy, University of Illinois at Chicago, 60612, Chicago, USA. beatrice.beckschimmer@uzh.ch.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Beck-Schimmer
authors.affiliation: Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001, Zurich, Switzerland. seifert@ifspm.uzh.ch.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zürich, Raemistrasse 100, 8091, Zürich, Switzerland. donat.spahn@usz.ch.
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zürich, Raemistrasse 100, 8091, Zürich, Switzerland. dominique.bettex@usz.ch.|Institute of Anaesthesiology, University Children's Hospital Zurich, 8032, Zurich, Switzerland. dominique.bettex@usz.ch.
authors.forename: Dominique
authors.initials: D
authors.lastname: Bettex
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D016207:Cytokines / Q000097:blood*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016276:Ventricular Function / Q000502:physiology; D055815:Young Adult
chemical_list: D016207:Cytokines