Effect of liver transplantation on intestinal permeabilityand correlation with infection episodes.

Francesca Romana Ponziani,Erida Nure,Giuseppe Marrone,Salvatore Agnes,Antonio Grieco,Venanzio Valenza,Maurizio Pompili,Antonio Gasbarrini,Gabriele Sganga,Giuseppe Bianco,Gianfranco D Alpini

doi:10.1371/journal.pone.0235359

Abstract

BackgroundLiver cirrhosis has been known to be associated with increased intestinal permeability (IP); however, little is known about the modification of IP after liver transplantation (LT). The present study was aimed to assess IP after LT and evaluated its association with laboratory tests and clinical parameters, as well as with the development of infections.MethodsLT recipients were consecutively enrolled and compared with an equal number of patients with liver cirrhosis and healthy subjects. IP was assessed by urinary excretion of chromium-51 ethylenediaminetetraacetic acid (51Cr-EDTA).ResultsThe median 51Cr-EDTA excretion was found to be higher in 35 LT recipients as compared with that in the healthy controls [4.77% (2.79–6.03) vs. 2.07% (1.57–2.42), p<0.0001], and comparable to that in the cirrhotic patients [3.69% (2.34–6.57), p = 0.445]. 51Cr-EDTA excretion was not associated with clinical variables, the type of immunosuppressive therapy, donor-related factors, comorbidities and incidence of infections [infection/no infection: 4.97% (3.14–7.03) vs 4.62% (2.79–5.82), p = 0.938].ConclusionLT recipients show an increased IP, similar to that in patients with liver cirrhosis. However, it is not associated with a high risk of infections. Further investigations into the pathogenesis of this persistent impairment of the intestinal barrier are warranted.

Highlights

Liver cirrhosis has been reported to be associated with an increase in the intestinal permeability (IP) [1]
The median 51Cr-EDTA excretion was found to be higher in 35 liver transplantation (LT) recipients as compared with that in the healthy controls [4.77% (2.79–6.03) vs. 2.07% (1.57–2.42), p
It is currently unknown whether LT could lead to a complete recovery of altered IP, which is commonly found in patients with liver cirrhosis

Summary

Introduction

Liver cirrhosis has been reported to be associated with an increase in the intestinal permeability (IP) [1]. Increased IP is associated with bacterial translocation and systemic inflammation, which together play a crucial role in the development of liver disease complications, such as hyperdynamic circulation, hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome [3]. These manifestations exert clear prognostic significance, as evident from an increased risk of mortality [4]. Recent studies have clearly shown that LT could exert a beneficial effect on gut dysbiosis in patients with liver cirrhosis These studies demonstrated an improvement in endotoxemia as well as in ammonia, bile acids, lipidomic and metabolomic profiles [6, 7]. The present study was aimed to assess IP after LT and evaluated its association with laboratory tests and clinical parameters, as well as with the development of infections

Objectives

Methods

Conclusion