Effect of selective plasmadsorption on systemic inflammatory response and cytokine levels in obstructed jaundice

Abstract

Objective: to study the effect of selective plasmadsorption (SPS) on the level of pro-inflammatory and anti-inflammatory plasma cytokines, markers of liver failure in patients with obstructive jaundice.Material and Methods. The study was conducted in 23 patients with prolonged obstructive jaundice. The baseline level of total bilirubin ranged from 285 μmol/L to 589 μmol/L. All patients were exposed to selective plasmadsorption before biliodigistic surgery and twice in the early postoperative period. Selective plasmosorption was carried using OctoNova by Asahi Kasei Medical (Japan) with the use of the sorbent based on the Plasorba BR-350 anion exchange resin. In one procedure, about two volumes of circulating plasma were treated.Results. Initial increase in the level of pro-inflammatory TNF-α, IL-1β, IL-6 cytokines as well as anti-inflammatory IL-10 cytokine was established.Following SPS, TNF-α level signifcantly decreased by 42.4% (p < 0.05). The decrease in IL-1β and IL-6 was 38.9% and 34.0%, respectively. The level of IL-10 signifcantly decreased by 30.7% (p < 0.05). A signifcant decrease in the levels of total bilirubin by 39.8 ± 3.8%, conjugated bilirubin (by 38.2%), unconjugated bilirubin (by 32.5%), ALT (by 23.5%), AST (by 37%), and bile acids (by 31.4%) was revealed by the end of the procedure. There were no hemorrhagic complications associated with SPS.Conclusions. Selective plasmosorption in complex treatment of patients with mechanical jaundice with hepatic insufciency in perioperative period reduces endotoxicosis level not only due to correction of biochemical markers of liver failure but also due to reduction of proinflammatory and anti-inflammatory cytokines.

Keywords

• liver failure
• obstructive jaundice
• selective plasmadsorption
• extracorporeal hemocorrection