Systemic cytokine response to hepatic resections under total vascular exclusion

Objective: To investigate the systemic cytokine response to major liver surgery as the basis for assessing potential new treatments. Design: Open prospective study. Setting: University hospital, UK. Subjects: Thirteen patients undergoing elective hepatic resections that involved total vascular exclusion of the liver. Interventions: Blood samples were taken preoperatively, during the operation, and during the first four postoperative days. Concentrations of endotoxin, interferon gamma (IFN-γ), tumour necrosis factor α (TNFα), interleukin-1 (IL-1), and interleukin-6 (IL-6) were measured. Results: Endotoxin concentrations were raised in 3/13 patients before operation and in 6 patients during the postoperative period. TNFα concentrations were undetectable. IFN-γ and IL-1 responses followed a low and inconclusive pattern. IL-6 was significantly increased from 6 hours after operation to the third postoperative day, peaking at 699 (±277) pg/ml at 24 hours (p < 0.01). The two patients who died had the highest postoperative concentrations of IL-6. Conclusions: There is a pronounced systemic response to hepatic resection under total vascular exclusion that is reflected by the increase in IL-6 concentration and correlates with the operative blood loss and postoperative outcome. This might be used as an indicator of the response to specific treatments in this type of surgery. Treatments that minimise the IL-6 response to major hepatic resection may be of value