Ischemic injury and liver graft congestion increase post-transplant interleukin-6 and tumor necrosis factor-alpha in hepatocellular carcinoma

Liver transplantation (LT) is an essential treatment for patients with end-stage liver disease (ESLD), including hepatocellular carcinoma (HCC). Post-transplant complications such as venous congestion and tumor recurrence remain challenging, and recent studies suggest that ischemia-reperfusion injury (IRI) and the resulting inflammatory response play a crucial role in these complications. This study was undertaken to investigate the relationship between early post-operative cytokine profiles and the development of venous congestion and tumor recurrence in LT recipients with HCC. 42 HCC patients that underwent living donor liver transplantation (LDLT) were prospectively studied. Data on liver chemistry, venous outflow reconstruction, plasma cytokine levels (IL-6, TNF-α, IL-10, MMP-1, and HGF), and tumor characteristics were collected. Venous congestion volume was assessed using CT scans, and plasma cytokines were measured multiple times post-LDLT. Elevated IL-6 and TNF-α levels were associated with early liver graft regeneration. Patients with ≥ 15% hepatic congestion showed elevated levels of these cytokines. A weak correlation was observed between ischemic events, congestion, and TNF-α levels. HCC recurrence was associated with higher IL-6 levels. IL-6 and TNF-α play a critical role in early graft regeneration. Venous congestion may significantly impact cytokine levels post-transplantation. Monitoring plasma cytokine profiles could be crucial for managing post-LDLT outcomes.