Release of Neopterin, PMN Elastase and Terminal Complement Complexes by Orthotopic Liver Transplantation with and without the Use of Veno-venous Bypass

Summary Aim: The aim of the study was to determine whether orthotopic liver transplantation leads to the activation of macrophages, neutrophils and complement. Patients and methods: Twenty-four patients undergoing orthotopic liver transplantation were studied. 12 were operated on with and 12 without the use of a veno-venous bypass. Blood samples for neopterin, PMN elastase and terminal complement complex (SC5b-9) determinations were drawn preoperatively, 1 minute before perfusion of the grafted liver and 2-5 and 30-60 minutes after the start of perfusion of the grafted liver. Comparisons were made between patients with or withour a veno-venous bypass and with or without postreperfusion syndrome (PRS) . PRS was defined as hypotension with ≥30% reduction of systemic mean arterial blood pressure during at least 1 minute after reperfusion of the grafted liver. Results: Release of neopterin was observed 2-5 and 30-60 minutes after the start of perfusion of the grafted liver in patients operated upon with and without the use of a veno-venous bypass. There were no significant differences in neopterin concentration between patients developing PRS and those without circulatory instability. Increased PMN elastase and SC5b-9 concentrations (p<0.05) were found 2-5 and 30-60 minutes after the start of reperfusion in both patients operated upon with and without a veno-venous bypass. The plasma concentrations of neopterin, PMN elastase and SC5b-9 were higher in patients with PRS compared with those without (p<0.05, respectively). Comments: This study indicates that orthotopic liver transplantation leads to the activation of macrophages, neutrophils and the complement cascade. There is no major difference regarding the activation between patients operated upon with and without the use of a veno-venous bypass.