Prospective Analysis of Perioperative Stress Response in Living Donor Liver Transplantation for Hepatitis B-Related Liver Disease

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dc.contributor.authorTuncer, Adem
dc.contributor.authorAkbulut, Sami
dc.contributor.authorSahin, Tevfik Tolga
dc.contributor.authorSatilmis, Basri
dc.contributor.authorOgut, Zeki
dc.contributor.authorDalda, Yasin
dc.contributor.authorYilmaz, Sezai
dc.date.accessioned2026-04-04T13:31:02Z
dc.date.available2026-04-04T13:31:02Z
dc.date.issued2025
dc.departmentİnönü Üniversitesi
dc.description.abstractBackground: Liver transplantation is a life-saving procedure for patients with end-stage liver disease, yet the immunological consequences of surgical trauma in these patients are not fully understood. The liver plays a central role in immune regulation, and its dysfunction in HBV-related chronic liver disease may alter the systemic stress response to surgery. Aim: This study aims to evaluate the stress response to surgical trauma of patients undergoing living donor liver transplantation (LDLT) for HBV-related chronic liver disease in comparison to living liver donors (LLDs). Methods: This prospective study included 20 LDLT recipients with HBV infection and 20 LLDs who underwent living donor hepatectomy between August 2020 and February 2021. Specific biochemical markers (IL-1, IL-4, IL-6, IL-22, IFN-gamma, TNF-alpha, TGF-beta, GM-CSF, GLDH, and GalactB) were measured at designated intervals: preoperative day 0 (Preop), immediately after incision (Incision), post-hepatectomy (Hepatectomy), postoperative day 0 (POD0), POD1, and POD3 using enzyme-linked immunosorbent assay (ELISA). Routine hematological and biochemical parameters (WBC, HGB, PLT, RDW, MPV, PDW, AST, ALT, ALP, GGT, albumin, total bilirubin, plateletcrit, phosphorus, fibrinogen, and INR) were measured regularly at five predetermined times: Preop, POD0, POD1, POD2, and POD3. Results: Prior to LDLT, LDLT recipients had significantly lower levels of pro-inflammatory cytokines (IL-1, IL-6, TNF-alpha, IFN-gamma) compared to LLDs (p < 0.05). However, following liver implantation, these cytokine levels increased significantly at POD0, POD1, and POD3 (p < 0.001). Specifically, IL-1 levels elevated from 0 in the preop period to 21.5 (97.5) in POD3, and IL-6 elevated from 0 in the preop period to 28.3 at POD3 (p = 0.056). Similarly, TNF-alpha and IFN-gamma levels exhibited significant upward trends (p < 0.05). In contrast, cytokine levels in LLDs remained stable throughout the perioperative period, revealing no statistically significant variations (p > 0.05). Routine hematological and biochemical parameters demonstrated significant postoperative fluctuations in LDLT recipients, reflecting the metabolic and immune restoration process. Conclusions: These findings indicate that patients with HBV-related chronic liver disease exhibit a diminished stress response to trauma due to underlying immune dysregulation caused by chronic hepatic dysfunction. However, after LDLT, the stress response gradually normalizes, suggesting that liver transplantation not only restores hepatic function but also reestablishes immune homeostasis, potentially reducing infection risks and improving postoperative recovery. These findings emphasize the crucial role of the liver in regulating the body's stress response to trauma and highlight the immunological benefits of LDLT in restoring immune homeostasis.
dc.description.sponsorshipInonu University Scientific Research Projects Coordination Unit [TSA-2020-2291]
dc.description.sponsorshipThe study was funded by the Inonu University Scientific Research Projects Coordination Unit (Project No: TSA-2020-2291). The authors extend their sincere gratitude to the Chair and all members of the Scientific Research Projects Coordination Unit for their valuable support and approval of this project. The authors also express their special thanks to the administrative personnel of the unit, including Erhan Yuce, Bahar K & imath;l & imath;c, Omer Baysar, and Ozgul Karaca, for their dedicated assistance and support throughout the conduct of this study.
dc.identifier.doi10.3390/jcm14248970
dc.identifier.issn2077-0383
dc.identifier.issue24
dc.identifier.orcid0000-0002-6864-7711
dc.identifier.orcid0000-0002-0701-8399
dc.identifier.orcid0000-0002-7698-9586
dc.identifier.orcid0000-0001-5381-513X
dc.identifier.orcid0000-0002-9132-6115
dc.identifier.orcid0000-0002-2538-5774
dc.identifier.orcid0000-0002-8044-0297
dc.identifier.pmid41464873
dc.identifier.scopus2-s2.0-105026063344
dc.identifier.scopusqualityQ1
dc.identifier.urihttps://doi.org/10.3390/jcm14248970
dc.identifier.urihttps://hdl.handle.net/11616/108546
dc.identifier.volume14
dc.identifier.wosWOS:001648335000001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherMdpi
dc.relation.ispartofJournal of Clinical Medicine
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WOS_20250329
dc.subjecthepatitis B virus infection
dc.subjectliving donor liver transplantation
dc.subjectliving donor hepatectomy
dc.subjectsurgical trauma
dc.subjectstress response
dc.subjectcytokines
dc.subjectimmune homeostasis
dc.titleProspective Analysis of Perioperative Stress Response in Living Donor Liver Transplantation for Hepatitis B-Related Liver Disease
dc.typeArticle

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