Hepat Mon. 2015 Nov 07;15(11):e31235. doi: 10.5812/hepatmon.31235. eCollection 2015 Nov.

Neutrophil Elastase Inhibitor Following Liver Resection: A Matched Cohort Study.

Hepatitis monthly

Shintaro Yamazaki, Tadatoshi Takayama, Masamichi Moriguchi, Yuki Hayashi, Yusuke Mitsuka, Nao Yoshida, Tokio Higaki

PMID: 26834789 PMCID: PMC4716668 DOI: 10.5812/hepatmon.31235

Abstract

BACKGROUND: Sivelestat is a neutrophil elastase inhibitor (NEI) with positive impact on the respiratory complications in thoracic surgery. Based on the findings of a recent study, NEI may have a good response for avoiding ischemia reperfusion injury in liver resection.

OBJECTIVES: The current study aimed to examine the impact of NEI on the postoperative outcomes after liver resection.

PATIENTS AND METHODS: The data were collected from 374 consecutive patients scheduled to undergo liver resection. Seven perioperative variables were matched on the basis of the patients' background. Then, the NEI (n = 61) and control (n = 61) groups were compared. NEI was administered at a dose of 0.2 mg/kg/h for three days from the postoperative day 0 (POD0). The liver function, coagulation activity, inflammatory response, respiratory complications, and overall complications were compared.

RESULTS: The levels of serum interleukin-6 (NEI group: 113 pg/mL [26.9 - 522.0] vs. control group: 174 [28.6 - 1040.6], P < 0.01) and C-reactive protein (CRP) (2.9 IU/L [range: 0.1 - 8.6] vs. 4.11 [0.3 - 13.8], P = 0.01) on the first postoperative day (POD1) and the alveolar-arterial oxygen tension difference (32.3 Torr [-28.6 - 132.3] vs. 46.6 [-11.2 - 251.6], P = 0.04) on the third postoperative day (POD3) were significantly lower in the NEI group than the control group. The rate of pleural effusion was significantly lower in the NEI group compared to that of the control group [13 patients (21.3%) vs. 23 (37.7%), P = 0.04]. However, the coagulation activities (P = 0.68), liver function (P = 0.69), non-respiratory complications (P = 0.84), and overall complications (P = 0.71) did not differ significantly between the groups.

CONCLUSIONS: Intravenous NEI administration had positive impact on the postoperative inflammatory response and oxygenation while it did not affect either coagulation or the liver function, as well as severe grade complications following resection.

Keywords: Complication; Liver Resection; Neutrophil Elastase Inhibitor

References

1. J Gastroenterol Hepatol. 2007 Jun;22(6):837-40 - PubMed
2. J Surg Res. 2009 Aug;155(2):311-7 - PubMed
3. World J Surg. 2012 May;36(5):1122-7 - PubMed
4. Br J Surg. 2012 Nov;99(11):1584-90 - PubMed
5. Langenbecks Arch Surg. 2007 Jan;392(1):45-54 - PubMed
6. Crit Care Med. 2004 Aug;32(8):1695-702 - PubMed
7. Eur J Pharmacol. 2004 Mar 19;488(1-3):173-80 - PubMed
8. Shock. 2007 Oct;28(4):401-5 - PubMed
9. Crit Care Med. 2002 May;30(5 Suppl):S281-7 - PubMed
10. Ann Surg. 2011 Jan;253(1):50-5 - PubMed
11. Arch Surg. 2011 Nov;146(11):1293-9 - PubMed
12. J Surg Res. 2013 Mar;180(1):e31-6 - PubMed
13. Dis Esophagus. 2007;20(6):478-86 - PubMed
14. Thorac Cardiovasc Surg. 2006 Sep;54(6):404-7 - PubMed
15. Interact Cardiovasc Thorac Surg. 2009 Jun;8(6):629-34 - PubMed
16. Br J Surg. 2003 Mar;90(3):302-5 - PubMed
17. Surg Today. 2006;36(4):321-6 - PubMed
18. World J Surg. 2007 Oct;31(10 ):1996-2001 - PubMed
19. Transplantation. 2010 May 15;89(9):1050-6 - PubMed
20. Transpl Int. 2003 May;16(5):341-6 - PubMed
21. Br J Surg. 2007 May;94(5):609-19 - PubMed
22. Semin Surg Oncol. 1993 Jul-Aug;9(4):298-304 - PubMed
23. Brain Res. 2009 Mar 9;1259:98-106 - PubMed
24. Anesthesiology. 1997 Sep;87(3):635-41 - PubMed
25. Int Arch Allergy Immunol. 1997 Mar;112(3):262-9 - PubMed

Publication Types

• Journal Article