Effects of bacterial translocation on hemodynamic and coagulation parameters during living-donor liver transplant

Abstract

Background: Bacterial translocation (BT) has been proposed as a trigger for stimulation of the immune system with consequent hemodynamic alteration in patients with liver cirrhosis. However, no information is available regarding its hemodynamic and coagulation consequences during liver transplantation.

Methods: We screened 30 consecutive adult patients undergoing living-donor liver transplant for the presence of BT. Bacterial DNA, Anti factor Xa (aFXa), thromboelastometry, tumor necrosis factor-α TNF-α, and interleukin-17 (IL-17) values were measured in sera before induction of anesthesia. Systemic hemodynamic data were recorded throughout the procedures.

Results: Bacterial DNA was detected in 10 patients (33%) (bactDNA(+)). Demographic, clinical, and hemodynamic data were similar in patients with presence or absence of bacterial DNA. BactDNA(+) patients showed significantly higher circulating values of TNF-α and IL-17, and had significantly higher clotting times and clot formation times as well as significantly lower alpha angle and maximal clot firmness than bactDNA(-) patients, P < 0.05. We found no statistically significant difference in aFXa between the groups, P = 0.4. Additionally, 4 patients in each group needed vasopressor agents, P = 0.2. And, the amount of transfused blood and blood products used were similar between both groups.

Conclusion: Bacterial translocation was found in one-third of patients at the time of transplantation and was largely associated with increased markers of inflammation along with decreased activity of coagulation factors.

Trial registration: Trial Registration Number: NCT03230214 . (Retrospective registered). Initial registration date was 20/7/2017.

Keywords: Bacterial DNA; Bacterial translocation; Coagulation factors; Liver transplantation.

Conflict of interest statement

Ethical approval and consent to participate

This study has been approved by the Ethics Committee of the Faculty of Medicine at the Alexanderia University, with approval number 020583. Informed written consents were obtained from all participants to participate in the study.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

EXTEM test. a clotting time (CT), b clot formation time (CFT), c alpha angle, d maximum clot firmness (MCF). * denotes significance relative to other group

Fig. 2

INTEM test. a clotting time (CT), b clot formation time (CFT), c alpha angle, d maximum clot firmness (MCF). * denotes significance relative to other group