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Comparison of urinary ulinastatin levels between donors and recipients immediately following adult living related donor liver transplantation
Comparison of Urinary Ulinastatin Levels Between Donors and Recipients Immediately Following Adult Living Related Donor Liver Transplantation T. Watanabe, Y. Sato, T. Ichida, S. Yamamoto, H. Oya, H. Nakatsuka, T. Kobayashi, and K. Hatakeyama
R
ECENTLY it has been reported that ulinastatin, or urinary trypsin inhibitor (UTI), which is produced in the liver,1 shows increased excretion in to the urine during acute pancreatitis, acute circulatory failure, infection, and surgical stress.2,3 UTI, which is a cytokine inhibitor,2 plays an important role in host defense during periods of stress. For this reason, we compared urinary ulinastatin levels between donors and recipients immediately following adult living related donor liver transplantation (ALRDLT).
lower than those of donors; however, early postoperative data showed recipients to display were higher amounts than donors (Fig 1). Early postoperative urinary ulinastatin levels among dead recipients were lower than those of live patients, although the differences were not statistically significant, namely, alive vs dead: 1 POD, 72.1 ⫾ 104.3 U/mL vs 20.6 ⫾ 9.08 U/mL; 3 POD, 91.6 ⫾ 100.3 U/mL vs 27.0 ⫾ 3.86 U/mL (Fig 2).
MATERIALS AND METHODS
DISCUSSION
The urinary ulinastatin levels are the preoperative day as well as 1, 3, 5, 7, and 14 days postoperatively were examined in seven recipients (32– 68 years old) and six living donors (20 – 43 years old), who underwent living related liver transplantation surgery from March to November 1999. Primary diseases were two cases of primary biliary cirrhosis, two of hepatocellular carcinoma for hepatitis C virus, one of hepatitis B cirrhosis, one Budd-Chiari syndrome, and one alcoholic liver cirrhosis. Two patients died due to cerebral hemorrharge and acute cardiac failure caused by aspergillus infection. Urinary ulinastatin levels were measured using the UTI ELISA kit (Mochida Cor). All recipients were administered 300,000 units of UTI (Miraclid).
Donor data suggest that UTI might be consumed in the early period following hepatectomy. Production of UTI was depressed in liver failure patients. Although the increase of UTI levels in the recipients was thought to be due to the administration of Miraclid, there was the possibility of a restored capacity of UTI production by the graft liver during the early operative period after ALRDLT. Postoperative UTI levels might reflect the graft function.
RESULTS
Urinary ulinastatin levels decreased gradually by 1 week in the donors, namely, mean preoprative value, 33.5 U/mL; 1 POD, 20.1 ⫾ 7.60 U/mL; 3 POD, 13.8 ⫾ 8.79 U/mL; 7 POD, 11.4 ⫾ 8.57 U/mL. Conversely, in the recipients, urinary ulinastatin levels increased during the first 5 postoperative days, thereafter decreasing (namely preoperative value 3.6 U/mL; 1 POD, 24.0 ⫾ 11.11 U/mL; 3 POD, 40.4 ⫾ 15.93 U/mL; 5 POD, 312.2 ⫾ 60.37 U/mL; 7 POD, 110.5 ⫾ 94.87 U/mL; 14 POD, 46.7 ⫾ 34.26 U/ml respectively. Preoperative urinary ulinastatin levels in recipients were
0041-1345/03/$–see front matter doi:10.1016/S0041-1345(02)03990-8 76
REFERENCES 1. Mizushima S, et al: Biol Pharm Bull 21:167, 1998 2. Ohnisihi H, et al: Jpn J Pharmacol 39:137, 1985 3. Ambiru S, et al: Dig Surg 17:337, 2002
From the Division of Digestive and General Surgery (T.W., Y.S., S.Y., H.O., H.N., T.K., K.H.) and Gastroenterology and Hepatology, (T.I.) Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. Address reprint requests to Dr Yoshinobu Sato, Division of Digestive and General Surgery, Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan. E-mail: [email protected]
© 2003 by Elsevier Science Inc. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 35, 76 –77 (2003)
URINARY ULINASTATIN LEVELS
77
Fig 1. Changes of UTI levels in donors and recipients following ALRDLT. Donors UTI levels decreased gradually by 1 week following liver transplantation. Conversely, recipients’ UTI increased by 5 days, and after then, they decreased by 2 weeks after transplantation.
Fig 2. Comparison of UTI levels between dead and live patients UTI levels in dead patients were lower than those in live patients.
R
ECENTLY it has been reported that ulinastatin, or urinary trypsin inhibitor (UTI), which is produced in the liver,1 shows increased excretion in to the urine during acute pancreatitis, acute circulatory failure, infection, and surgical stress.2,3 UTI, which is a cytokine inhibitor,2 plays an important role in host defense during periods of stress. For this reason, we compared urinary ulinastatin levels between donors and recipients immediately following adult living related donor liver transplantation (ALRDLT).
lower than those of donors; however, early postoperative data showed recipients to display were higher amounts than donors (Fig 1). Early postoperative urinary ulinastatin levels among dead recipients were lower than those of live patients, although the differences were not statistically significant, namely, alive vs dead: 1 POD, 72.1 ⫾ 104.3 U/mL vs 20.6 ⫾ 9.08 U/mL; 3 POD, 91.6 ⫾ 100.3 U/mL vs 27.0 ⫾ 3.86 U/mL (Fig 2).
MATERIALS AND METHODS
DISCUSSION
The urinary ulinastatin levels are the preoperative day as well as 1, 3, 5, 7, and 14 days postoperatively were examined in seven recipients (32– 68 years old) and six living donors (20 – 43 years old), who underwent living related liver transplantation surgery from March to November 1999. Primary diseases were two cases of primary biliary cirrhosis, two of hepatocellular carcinoma for hepatitis C virus, one of hepatitis B cirrhosis, one Budd-Chiari syndrome, and one alcoholic liver cirrhosis. Two patients died due to cerebral hemorrharge and acute cardiac failure caused by aspergillus infection. Urinary ulinastatin levels were measured using the UTI ELISA kit (Mochida Cor). All recipients were administered 300,000 units of UTI (Miraclid).
Donor data suggest that UTI might be consumed in the early period following hepatectomy. Production of UTI was depressed in liver failure patients. Although the increase of UTI levels in the recipients was thought to be due to the administration of Miraclid, there was the possibility of a restored capacity of UTI production by the graft liver during the early operative period after ALRDLT. Postoperative UTI levels might reflect the graft function.
RESULTS
Urinary ulinastatin levels decreased gradually by 1 week in the donors, namely, mean preoprative value, 33.5 U/mL; 1 POD, 20.1 ⫾ 7.60 U/mL; 3 POD, 13.8 ⫾ 8.79 U/mL; 7 POD, 11.4 ⫾ 8.57 U/mL. Conversely, in the recipients, urinary ulinastatin levels increased during the first 5 postoperative days, thereafter decreasing (namely preoperative value 3.6 U/mL; 1 POD, 24.0 ⫾ 11.11 U/mL; 3 POD, 40.4 ⫾ 15.93 U/mL; 5 POD, 312.2 ⫾ 60.37 U/mL; 7 POD, 110.5 ⫾ 94.87 U/mL; 14 POD, 46.7 ⫾ 34.26 U/ml respectively. Preoperative urinary ulinastatin levels in recipients were
0041-1345/03/$–see front matter doi:10.1016/S0041-1345(02)03990-8 76
REFERENCES 1. Mizushima S, et al: Biol Pharm Bull 21:167, 1998 2. Ohnisihi H, et al: Jpn J Pharmacol 39:137, 1985 3. Ambiru S, et al: Dig Surg 17:337, 2002
From the Division of Digestive and General Surgery (T.W., Y.S., S.Y., H.O., H.N., T.K., K.H.) and Gastroenterology and Hepatology, (T.I.) Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. Address reprint requests to Dr Yoshinobu Sato, Division of Digestive and General Surgery, Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan. E-mail: [email protected]
© 2003 by Elsevier Science Inc. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 35, 76 –77 (2003)
URINARY ULINASTATIN LEVELS
77
Fig 1. Changes of UTI levels in donors and recipients following ALRDLT. Donors UTI levels decreased gradually by 1 week following liver transplantation. Conversely, recipients’ UTI increased by 5 days, and after then, they decreased by 2 weeks after transplantation.
Fig 2. Comparison of UTI levels between dead and live patients UTI levels in dead patients were lower than those in live patients.