Changes in the Ratio of T Helper 1 to T Helper 2 Signature Cytokines in Patients Undergoing Living Donor Liver Transplantation Surgery: A Prospective Controlled Study

Abstract

BackgroundThe balance between T helper 1 (Th1) and T helper 2 (Th2) signature cytokines plays a critical role in the immune response. The aim of this study was to evaluate the Th1 to Th2 cytokine ratio in healthy persons and patients with cirrhotic hepatitis and to investigate changes in the Th1 to Th2 cytokine ratio during living donor liver transplantation (LDLT) surgery. MethodsEighty patients were allocated to each of the donor and recipient groups. In the recipient group, signature cytokines—interferon gamma (IFN-γ) and tumor necrosis factor α (TNF-α) as Th1 and interleukin 6 (IL-6) and interleukin 10 (IL-10) as Th2—were quantified after induction of anesthesia (baseline, stage 1), 60 minutes after the start of the anhepatic phase (stage 2), and 60 minutes after reperfusion (stage 3). In the donor group, cytokine levels were analyzed only at stage 1. The Th1/Th2 cytokine ratios at baseline and over time during surgery in the recipient group were evaluated. ResultsAt stage 1, the recipient group exhibited higher levels of all cytokines than the donor group. However, the IFN-γ/IL-6, IFN-γ/IL-10, TNF-α/IL-6, and TNF-α/IL-10 ratios of the groups were comparable. The levels of all cytokines, except IFN-γ, increased during LDLT. The IFN-γ/IL-6, IFN-γ/IL-10, TNF-α/IL-6, and TNF-α/IL-10 ratios declined significantly during LDLT. ConclusionsThe preoperative Th1/Th2 cytokine ratios were similar in healthy persons and patients with cirrhotic hepatitis. During LDLT surgery, Th2 activity was enhanced, as indicated by a shift in the Th1/Th2 cytokine ratio toward Th2.