Avaliação dos receptores solúveis do fator de necrose tumoral como preditor de disfunção miocárdica durante transplante hepático

Abstract

Introduction: Cirrhotic patients have an exacerbated inflammatory status, with high plasma levels of tumor necrosis factor alpha (TNF-alpha) and of soluble 1 and 2 of TNF alpha (sTNF-R1 and sTNF-R2). The anhepatic phase of the liver transplant (LT) is considered critical as intense changes occur in the cardiovascular system (CVS). The purpose of this study was to evaluate the preoperative plasma dose of sTNF-R1 and sTNF-R2 in order to identify patients at risk of a poor hemodynamic evolution during the anhepatic phase. Method: One hundred and one adult patients (73 males - 72.2%) who were submitted to orthotopic cadaver donor liver transplant, preserving the retrohepatic vena cava inferior (piggyback technique), performed at Hospital das Clínicas of Universidade Federal de Minas Gerais (HC-UFMG) were evaluated in our study. Preoperative plasma doses of sTNF-R1 and sTNF-R2, preoperative use of propranolol as well as other clinical and surgical characteristics, were compared between the groups with a favorable outcome - increase (group I, n=28) and with an unfavorable outcome decrease (Group II, n=73) of the cardiac index (CI) during the anhepatic phase of the LT. Results: There were no significant differences in the severity of the MELD system between the I and II groups (p=0.36). Serum concentration of sTNF-R1 in the group I (3902[507-19692]) was not significantly different from the group II (3539[336- 31491]), p=0.61; and the same happened regarding sTNF-R2 in the favorable (4137[1997- 13264]) and unfavorable outcomes (4113[2256-15954]), p=0.63. Patients who received propranolol preoperatively in the group I (46.4%) were statistically similar to those of the group II (56.2%), p=0.38. The median of serum concentrations of sTNF-R1 (3576[444- 31491]) and of sTNF-R2 (3862[1997-1594]) in the Non-beta-blocker group was statistically similar when compared with concentrations of sTNF-R1 (3500[336-11377]) and of sTNF-R2 (4179[2384-10328]) in the Beta-blocker group. Conclusions: Preoperative serum levels of sTNF-R1 and sTNF-R2 have not been associated with a decreased CI in the anhepatic phase of the LT. Preoperative administration of propranolol may be considered safe as it has not been associated with a decreased CI in the anhepatic phase of the LT. Preoperative administration of propranolol there was no association with preoperative serum levels of sTNF-R1 and sTNF-R2.