Endotoxemia is common following abdominal organ transplantation and is associated with reperfusion and rejection

Abstract

Objective. Patients undergoing orthotopic liver transplantation (OLT) and multi-visceral transplantation (MVT) may have an increased incidence of endotoxemia due to translocation of endotoxin from the intestine, in combination with impaired hepatic clearance. We sought to evaluate the presence of endotoxemia in the perioperative period, using the Endotoxin Activity Assay™ (EAA) to understand the association of endotoxin activity (EA) with clinical course and outcome. Material and methods. In this prospective observational pilot study we measured EA in 40 patients undergoing OLT or MVT during the perioperative period. As a control, the EAA was performed on 10 healthy adult volunteers. We analyzed the relationships between EA and graft function, episodes of rejection, infection and outcome. Results. Mean EA in the control group was 0.21±0.05 u (range 0.16–0.27 u). For patients, baseline pre-transplant EA was significantly greater than that in controls at 0.50±0.17 u (range 0.10–0.80 u) (p=0.001) and further increased post-reperfusion (p=0.018) during OLT, especially in patients who developed post-reperfusion syndrome (PRS) (p=0.029). In the postoperative phase, EA remained elevated (>0.40 u) in nearly 75% of patients for up to 1 month post-surgery but was greatest (>0.60 u) for patients who developed infection. However, postoperative EA did not correlate with length of hospital or intensive care unit stay or with 90-day survival. Conclusions. High EA is common before, during and after abdominal organ transplantation and is associated with PRS, infection and rejection. However, unlike other critically ill patients, high EA in this cohort does not necessarily affect short-term prognosis. Further study will delineate the utility of measuring EA in the abdominal transplant population.