Cytokine balance in hepatosplanchnic system during

Authors: Takashi Kunihara Suguru Kubota Norihiko Shiiya Kenji Iizuka Shigeyuki Sasaki Satoru Wakasa Kenji Matsuzaki Yoshiro Matsui

Publish Date: 2011/06/24

Volume: 14, Issue: 3, Pages: 192-200

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Abstract

While prolonged visceral ischemia seems to be a potential source of elevated proinflammatory cytokines during thoracoabdominal aortic aneurysm TAAA repair the underlying mechanisms are unclear We have investigated the production of cytokines and fatty acid binding proteins FABPs in the hepatosplanchnic system during TAAA repair Arterial and hepatic venous levels of tumor necrosis factoralpha TNFα interleukin IL 6 8 and 10 and liver and intestinaltype FABPs LFABP IFABP were measured at four time points in ten patients undergoing TAAA repair Visceral arteries were perfused through either a sidearm of distal aortic perfusion or an individual circuit using an independent pump or both without measuring perfusion pressure or blood flow The postoperative courses of all patients were uneventful During visceral perfusion the levels of arterial IL6 8 and 10 and LFABP elevated significantly P = 00077 00051 00077 00077 respectively and these elevated levels persisted up to skin closure with the exception of LFABP P = 00051 each In contrast there were only subtle increases in TNFα and IFABP levels The production ratio through the hepatosplanchnic system of TNFα LFABP and IFABP showed a pronounced peak during visceral perfusion but only the peak of LFABP was significant compared with baseline P = 00077 All production ratios returned to baseline level at skin closure The production ratio of IL6 was negative throughout the operation and that of IL8 and IL10 remained at baseline during visceral perfusion In conclusion a portion of the TNFα LFABP and IFABP might be produced temporarily in the hepatosplanchnic system during TAAA repair Systemic elevation of IL6 IL8 and IL10 might be modulated by inflammatory response to extracorporeal circulation or surgical stress Thus our simple visceral perfusion techniques may indeed be justified

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