Evaluation of stress response to trauma in patients who received living donor liver transplantation for hepatitis b virus related chronic liver disease: Prospective case control study

Evaluation of Stress Response to Trauma in Patients Who Received Living Donor Liver Transplantation for Hepatitis B Virus Related Chronic Liver Disease: Prospective Case Control Study Aim and Background: The aim of the present study was to evaluate the stress response to surgical trauma in patients who received living donor liver transplantation (LDLT) due to Hepatitis B Virus (HBV) related chronic liver disease in comparison to individuals to whom living donor hepatectomy (LDH) was performed. Materials and Methods:Between August 2020 and February 2021 recipients who received LDLT for HBV related chronic liver disease and donors who received LDH were included in the case and control groups; respectively. Our power analyses showed that minimum number of participants in each group should be at least 20. Serum samples from all the participants were obtained at preoperative, at the time of incision, hepatectomy, postoperative 2nd hour, and postoperative first and 3rd days. Routine biochemical analysis, complete blood count were studied; and also specific parameters including IL-1, IL-6, IFN-ɣ, TNF-α, glutamate dehydrogenase, and β-galactosidase were studied at designated time intervals for all the participants. Specific parameterswere studied in our institute's hepatology research laboratory via enzyme linked immunosorbent assay (ELISA) kits. Results:The cytokines reflecting the stress response to trauma were significantly lower in the recipients when compared to the donors (p<0.05). The cytokine response gradually increased following implantation of the liver grafts in the recipients (p<0.001). On the other hand, the cytokine response did not change significantly in the preoperative and postoperative time intervals in the donors (p>0.05). Conclusions: Our results suggest that, in patients with HBV related chronic liver disease, the stress response to trauma is reduced. Furthermore, it is observed that the stress response to trauma gradually increases after the implantation of the healthy liver graft. Our observations clearly show that in end-stage liver failure that requires liver transplantation, the body's natural immune response is severely deranged and this condition is reversible by liver transplantation. Key Words: Hepatitis B Virus, liver transplantation, stress response to trauma, natural immunity