Evaluation of Preoperative Soluble TNF-alpha Receptors 1 and 2 as Predictors of Hemodynamic Outcome Through the Anhepatic Phase of Orthotopic Liver Transplantation.

Abstract

The purpose of this study was to evaluate the preoperative sTNF-R1 and sTNF-R2 plasma levels in order to identify patients at risk of poor hemodynamic outcome during the anhepatic phase of liver transplantation (LT). One hundred and one adult patients (72.2% males) submitted to orthotopic cadaveric donor LT by the piggyback technique were evaluated. Preoperative sTNF-R1 and sTNF-R2 levels and clinical/surgical data were compared between patients with a favorable outcome (Group I, n=28) and with an unfavorable outcome (Group II, n=73) of the cardiac index (CI) through the anhepatic phase of LT. The characteristics of Groups I and II are displayed on table 1.Table: No Caption available.The sTNF-R1 and sTNF-R2 levels were not different [sTNF-R1 (3902[507-19692])-Group I vs (3539[336-31491])-Group II, p=0.61; sTNF-R2 (4137[1997-13264])-Group I vs (4113[2256-15954])-Group II, p=0.63]. The number of patients taking propranolol preoperatively was similar (Group I = 46.4% vs Group II = 56.2%; p=0.38). The median of sTNF-R1 and sTNF-R2 levels in the non-beta-blocker group was similar to the beta-blocker group - sTNF-R1 (3576[444-31491]) vs (3500[336-11377]) and sTNF-R2 (3862[1997-1594]) vs (4179[2384-10328]). Conclusions: Preoperative sTNF-R1 and sTNF-R2 levels had not been associated with a decrease in CI through the anhepatic phase of LT. Preoperative use of propranolol was not associated with preoperative sTNF-R1 and sTNF-R2 levels and had not been associated with a decrease in CI through the anhepatic phase of LT.