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First report of cytokine removal using CytoSorb® in severe noninfectious inflammatory syndrome after liver transplantation.
Tomescu DR1,2, Olimpia Dima S3, Ungureanu D4, Popescu M2, Tulbure D2,4, Popescu I2,3.
Author information
1?Department of Anesthesiology and Critical Care III, Fundeni Clinical Institute, Bucharest - Romania.
2?University of Medicine and Pharmacy "Carol Davila", Bucharest - Romania.
3?Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest - Romania.
4?Department of Anesthesiology and Critical Care I, Fundeni Clinical Institute, Bucharest - Romania.
Abstract
INTRODUCTION:
Emergency transplantation of a donor liver that is not matched for the major blood antigens can produce marked immune-mediated cytokine release that can cause donor graft loss. Control of the inflammatory response may be a key element in treatment.
METHODS:
We present the case of a 46-year-old man with primary graft nonfunction after liver transplantation who underwent emergency retransplantation with an ABO-incompatible graft. A severe inflammatory response syndrome (SIRS) was noted in the perioperioperative period of retransplantation. The patient was successfully treated for this condition with a new hemoadsorption column (CytoSorb®), in combination with continuous venovenous hemofiltration (CVVH) throughout the intraoperative and early postoperative period.
RESULTS:
During and after each treatment a significant and rapid decrease of pro- and anti-inflammatory cytokines was observed, especially for interleukin-6 (IL-6), IL-10 and monocyte chemotactic protein 1 (MCP-1). Reduction of cytokines was associated with normalization of cardiac output and systemic vascular resistance, and improved liver function.
CONCLUSIONS:
We believe this is the first case in which hemoadsorptionin combination with CVVH has been used to manage SIRS in a patient with primary graft nonfunction undergoing emergency retransplantation.

http://www.ncbi.nlm.nih.gov/pubmed/27079418