Characteristics of oxidative stress changes in patients during perioperation of liver transplantation

Abstract

Objective To explore the characteristics of oxidative stress changes in recipients of different primary diseases during perioperation of liver transplantation. Methods Thirty patients who underwent orthotopic liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from May 2012 to March 2013 were enrolled in this prospective study. According to different primary diseases, the patients were divided into hepatocellular carcinoma (HCC) group, hepatitis B cirrhosis (cirrhosis) group, chronic severe hepatitis(CSH) group. There were 13 cases in HCC group with 9 males, 4 females, 24-62 years old and median age of 45 years old. There were 8 cases in cirrhosis group with 5 males, 3 females, 28-65 years old and median age of 43 years old. There were 9 cases in CSH group with 6 males, 3 females, 30-60 years old and median age of 42 years old. The informed consents of all patients were obtained and the ethical committee approval was received. All the patients underwent modified piggyback orthotopic liver transplantation under general anesthesia with tracheal intubation. The malondialdehyde (MDA), hydroxyl free radical (·OH), glutathione s-transferase (GST) levels and total antioxidant capacity (T-AOC) were examined at 4 time points: pre-operation and after induction (T1), 1 h after reperfusion (T2), 3 h after reperfusion (T3) and 24 h after reperfusion (T4). The indexes of oxidative stress in three groups were expressed in M[Q25, Q75] and were compared by Kruskal-Wallis rank sum test. Results The MDA levels at T1, T2, T3 were 70(33, 123), 64(34, 125), 75(40, 140)μmol/L respectively in HCC group, were 33(24, 42), 32(31, 41), 43(30, 52)μmol/L respectively in cirrhosis group and were 94(69, 528), 65(54, 311), 92(53, 312)μmol/L respectively in CSH group. The MDA level was the highest in CSH group and the lowest in cirrhosis group, and significant differences were observed among three groups (Z=9.45, 9.36, 8.92; P<0.05). The ·OH level at T3 were 1617(1330, 2179), 2715(2192, 3025), 1744(1568, 2429)kU/L respectively in HCC group, cirrhosis group and CSH group. The ·OH level at T3 was the highest in cirrhosis group and the lowest in HCC group, and significant difference was observed among three groups (Z=7.29, P<0.05). The GST levels at T2 were 297(256, 317), 433(381, 480), 367(278, 545)kU/L respectively in HCC group, cirrhosis group and CSH group. The GST level at T2 was the highest in cirrhosis group and the lowest in HCC group, and significant difference was observed among three groups (Z=9.26, P<0.05). The T-AOC at T1, T2, T3, T4 were 8(5, 12), 6(5, 10), 8(5, 11), 11(6, 14)kU/L respectively in HCC group, were 6(5, 11), 8(5, 12), 13(7, 14), 6(6, 14) kU/L respectively in cirrhosis group and were 15(9, 20), 11(9, 18), 15(12, 22), 25(20, 31)kU/L respectively in CSH group. The TAOC at all time points were the highest in CSH group (Z=10.48, 6.59, 11.42, 11.68; P<0.05). Conclusions Oxidative stress reaction occurs during the perioperation of liver transplantation. The different degree of oxidative damage is caused by different primary diseases. The oxidative damage is more severe in patients with chronic severe hepatitis than patients with HCC and hepatitis B cirrhosis. Key words: Liver transplantation; Oxidative stress; Hepatitis B, chronic; Carcinoma, hepatocellular; Liver cirrhosis