Association between Early Acute Respiratory Distress Syndrome after Living-Donor Liver Transplantation and Perioperative Serum Biomarkers: The Role of Club Cell Protein 16

Chun-Yu Wu, Ya-Jung Cheng, Ming-Hui Hung, I-Ju Lin, Wei-Zen Sun, Kuang-Cheng Chan, Chun-Yu Wu, Ya-Jung Cheng, Ming-Hui Hung, I-Ju Lin, Wei-Zen Sun, Kuang-Cheng Chan

Abstract

Background: Acute respiratory distress syndrome (ARDS) after living-donor liver transplantation (LDLT) is not uncommon, but it lacks the biomarkers for early detection. Club cell protein 16 (CC16), high-motility group box 1 protein (HMGB1), interleukin-1β (IL-1β), and IL-10 have been reported as relevant to the development of ARDS. However, they have not been investigated during LDLT.

Methods: Seventy-three consecutive recipients undergoing LDLT were enrolled and received the same perioperative care plan. Perioperative serum CC16, HMGB1, IL-1β, and IL-10 levels were measured at the pretransplant state, 30 minutes after reperfusion, postoperative day 1 (POD1), and POD3. ARDS was diagnosed according to the 2012 Berlin definition.

Results: Of the 73 recipients, 13 developed ARDS with significantly longer durations of mechanical ventilation and intensive care unit stay. Serum CC16 levels on POD1 increased significantly from the pretransplant state in the ARDS group but not in the non-ARDS group. Pretransplant serum CC16 levels were also higher in the ARDS group. The area under the receiver operating characteristic curves for POD1 serum CC16 levels used to discriminate ARDS was 0.803 (95% confidence interval: 0.679 to 0.895; p < 0.001). By comparison, HMGB1, IL-1β, and IL-10 were not associated with ARDS after LDLT.

Conclusion: The higher pretransplant serum CC16 level and its increased level on POD1 were associated with the development of early ARDS after LDLT. This trial is registered with NCT01936545, 27 August 2013.

Figures

Figure 1
Figure 1
Changes in perioperative serum anti-inflammatory biomarkers consisting of club cell protein 16 (CC16) (Figure 1(a)) and interleukin-10 (IL-10) (Figure 1(b)) in nonacute respiratory distress syndrome (ARDS) and ARDS groups. ∗ indicates a significant difference of p < 0.05 between the groups. # indicates a significant change compared with the pretransplant state of p < 0.05 within the groups.
Figure 2
Figure 2
Changes in perioperative proinflammatory biomarkers consisting of high-motility group box 1 protein (HMGB1) (Figure 2(a)) and interleukin-1β (IL-1β) (Figure 2(b)) in nonacute respiratory distress syndrome (ARDS) and ARDS groups.
Figure 3
Figure 3
Receiver operating characteristic curves describing the ability of serum club cell protein 16 (CC16) levels early in the morning on postoperative day 1 in discriminating early postoperative acute respiratory distress syndrome.

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