P309 The effects of preoperative adsorptive leukocytapheresis on inflammatory cytokines and septic complications after restorative proctocolectomy for ulcerative colitis: a prospective randomized study
T. Yamamoto*, T. Shimoyama, K. Matsumoto
Yokkaichi Hazu Medical Centre, Inflammatory Bowel Disease Centre, Yokkaichi, Japan
Granulocyte, monocyte/macrophage adsorption (GMA) has produced significant clinical efficacy together with down modulation of specific inflammatory cytokines in patients with ulcerative colitis (UC). This study was to investigate if preoperative GMA produces immunosuppressive effect on dysregulated immune activity and septic complications after restorative proctocolectomy (RPC) in patients with UC.
Forty patients requiring RPC were included. Twenty randomly selected patients received 5 GMA sessions over 2 consecutive weeks prior to RPC (GMA group). RPC was performed within 2 weeks after the last GMA. The other 20 patients did not receive GMA prior to RPC (non-GMA group). Interleukin (IL)-1β, IL-6 and tumour necrosis factor (TNF)-α in plasma and peritoneal fluid from a drainage tube were measured on postoperative days 0, 1, 3 and 7. Incidence of septic complications (anastomotic leak, fistula, intra-abdominal abscess or wound infection) and cytokine levels were monitored. Leukocyte and platelet counts, and C-reactive protein (CRP) levels were also measured perioperatively.
Between the two groups, patients were matched with respect to age, sex, UC duration, severity, extent and the dose of prednisolone at surgery. Septic complications occurred in 3 patients (15%) in each group. IL-1β, IL-6 and TNF-α levels in plasma and peritoneal fluid were not significantly different between the two groups during the entire study period. Similarly, leukocyte and platelet counts, and CRP levels were not significantly different between the two groups during the study period.
Based on the assays of IL-1β, IL-6 and TNF-α levels in the plasma and the peritoneal fluid, this study did not show any immunosuppressive effect on these cytokines by preoperative GMA in patients with UC who underwent RPC. Likewise, GMA did not affect the incidence of septic complications.