Abstract
Objectives: To elucidate the kinetics of endotoxin and (1→3)-β-D-glucan (β-D-glucan) as well as to clarify the mechanisms of changes of these variables in patients undergoing cardiopulmonary bypass (CPB) or living donor orthotopic liver transplantation (OLT), we made prospective observational study. Methods: Fifteen patients undergoing CPB and 10 patients with OLT were investigated. Male Wister rats were used for experimental study. Plasma levels of endotoxin, β-D-glucan, prothrombin fragment1+2 (PF1+2), and soluble fibrin (SF) were measured at several points during the operations. Sterilized gauzes immersed in 2ml saline were administered in rats intraperitoneally. Blood was collected from jugular vein at 4 hours after the administration. Sham operated rats were used as control. Results: No endotoxin was detected throughout the studies, however β-D-glucan levels showed significant elevations during the CPB and OLT surgeries. In patients with OLT surgery, high levels of PF1+2 and SF were also noted. There were significant correlations between the levels of β-D-glucan and the volume of blood loss or transfusion. We found marked elevations in the plasma levels of β-D-glucan from the rats administered gauzes intraperitoneally. Conclusions: No endotoxin but β-D-glucan could be detected during CPB and OLT surgeries. Exogenous β-D-glucan in surgical gauzes and impaired clearance from dysfunctioning liver might be one of the causes of the high β-D-glucan levels during the surgery.
