Evaluation of response of transplanted graft to sepsis in patients who developed abdominal sepsis after liver transplantation

Introduction and Objective: Sepsis is a difficult condition to treat with high mortality and complex pathophysiological events. Blood samples were taken from the patients for the examination of cytokines, hematological, and biochemical markers. It was aimed to evaluate the sepsis response of patients who underwent liver transplantation and developed abdominal sepsis as a result of tissue examinations performed under histologically electron microscope and pathologically under the light microscope. Materials and Methods: This study was carried out prospectively on 24 consecutive patients who underwent liver transplantation at Inonu University Liver Transplantation Institute and were diagnosed with sepsis of abdominal origin. Descriptive data of the patients such as age, gender, diagnosis, length of stay, SOFA scores, transplant indications, sepsis etiology leading to relaparotomy were recorded. Blood, intraabdominal fluid, urine, respiratory samples and laboratory values taken from the patients were recorded. Biopsy samples taken from the transplanted liver after relaparotomy were sent to histology and pathology laboratories in appropriate solutions. In addition, blood samples were stored to measure the levels of inflammatory cytokines. IL-4, IL-6, IL-10, IL-17, TREM1, sHLA-G, TNF-α, TGF-β, IFN-γ values were studied from the serum samples stored at the end of the study. Results: As a result of the study, three groups were formed and evaluated within themselves. The retransplantation rate was significantly different in the culture positive and negative groups (12.5% vs 50%; p= 0.046). Although it was not statistically significant in culture positive patients, mortality was higher (p=0.54). TREM-1 was higher in the culture positive group (1682 vs 1085.3 pg/ml; p=0.027). AST and ALT were significantly higher in culture negative patients (p= 0.03 and p=0.004, respectively). AST values were 42.5 (13-14830) and 111 (47-3070) IU/L in culture positive and culture negative groups, respectively. In culture positive and culture negative groups, ALT values were 48.5 (13-5921) and 195.5 (112-3276) IU/L, respectively. In the survival group, the mortality rate was higher in male patients (87.5% vs 12.5%; p=0.02). Mortality rate in patients with retransplantation was found to be significantly different than those without retransplantation (50% vs 12%; p=0.04). Fibrinogen was found to be statistically lower in patients with mortality compared to living patients (97.6 vs 220 mg/dl; p=0.001); however, total bilirubin (18.3 vs 5.1 mg/dl; p=0.006) and PTZ (20.5 vs 15.2 sec; p=0.009) were found to be significantly higher. In the group evaluated according to gender, AST, ALT, LDH, ammonia and lactate levels were found to be significantly higher in men than in women (respectively; p=0.012, p=0.016, p=0.014, p=0.03, p=0.048). Only fibrinogen levels were found to be statistically higher in women (p=0.04). There was no significant difference in other parameters in all three groups. In electron and light microscopic examination; symptoms supporting sepsis such as cholestasis, necrosis, intracellular organelle changes, steatosis, and tissue rejection were encountered. Conclusion: This study shows that many laboratory parameters and cellular tissue changes occur in patients with sepsis after liver transplantation.