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. Forty-two patients with HCC who 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 tended to show elevated levels of these cytokines. A weak association 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 be associated with altered cytokine levels post-transplantation. Monitoring plasma cytokine profiles could be crucial for managing post-LDLT outcomes.