Research Report
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World J Hepatol. May 27, 2014; 6(5): 340-346
Published online May 27, 2014. doi: 10.4254/wjh.v6.i5.340
CYP2E1 immunoglobulin G4 subclass antibodies after desflurane anesthesia
Chrysanthi Batistaki, George Michalopoulos, Paraskevi Matsota, Tzortzis Nomikos, Konstantinos Kalimeris, Maria Riga, Maria Nakou, Georgia Kostopanagiotou
Chrysanthi Batistaki, George Michalopoulos, Paraskevi Matsota, Konstantinos Kalimeris, Maria Riga, Maria Nakou, Georgia Kostopanagiotou, 2nd Department of Anesthesiology, School of Medicine, University of Athens, “Attikon” University Hospital, 12462 Athens, Greece
George Michalopoulos, Department of Gastroenterology, “Tzaneion” Peripheral General Hospital, 18536 Piraeus, Greece
Tzortzis Nomikos, Department of Nutrition and Dietetics, Harokopio University, 17671 Athens, Greece
Author contributions: All authors made substantial contributions to the conception and design, acquisition of data or analysis and interpretation of the data; drafted the article or revised it, critically, for important intellectual content; and provided final approval for the version to be published; Batistaki C and Michalopoulos G contributed equally to this work, with regards to the conception and design, the conduct of the study, acquisition of data, analysis and interpretation of data, and manuscript preparation; Matsota P and Kalimeris K contributed to study design and manuscript preparation; Riga M and Nakou M contributed to conducting the study; Nomikos T contributed to biochemical analysis of data; and Kostopanagiotou G contributed to study design and manuscript preparation.
Correspondence to: Chrysanthi Batistaki, Assistant Professor of Anesthesiology, 2nd Department of Anesthesiology, School of Medicine, University of Athens, “Attikon” University Hospital, 1 Rimini str, 12462 Athens, Greece.
Telephone: +30-694-1466185 Fax: +30-210-5326413
Received: November 2, 2013
Revised: January 20, 2014
Accepted: March 3, 2014
Published online: May 27, 2014

AIM: To investigate CYP2E1 IgG4 autoantibody levels and liver biochemical markers in adult patients after anesthesia with desflurane.

METHODS: Forty patients who were > 18 years old and undergoing elective surgery under general anesthesia with desflurane were studied. Alpha-glutathione-S-transferase (αGST) and IgG4 antibodies against CYP2E1 were measured preoperatively and 96 h postoperatively, as well as complete blood count, prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), aspartate aminotransferase (SGOT), alanine aminotransferase (SGPT), g-glutamyl-transpeptidase (gGT), alkaline phosphatase, total serum proteins, albumin and bilirubin. A separate group of 8 patients who received regional anesthesia was also studied for calibration of the methodology used for CYP2E1 IgG4 and αGST measurements. Student’s t-test and the Mann-Whitney U test were used for comparison of the continuous variables, and Fisher’s exact test was used for the categorical variables. All tests were two-tailed, with statistical significance set as P < 0.05.

RESULTS: None of the patients developed postoperative liver dysfunction, and all patients were successfully discharged from the hospital. No statistically significant difference was observed regarding liver function tests (SGOT, SGPT, γGT, bilirubin, INR), αGST and CYP2E1 IgG4, before and after exposure to desflurane. After dividing patients into two subgroups based on whether or not they had received general anesthesia in the past, no significant difference in the levels of CYP2E1 IgG4 was observed at baseline or 96 h after desflurane administration (P = 0.099 and P = 0.051, respectively). Alpha-GST baseline levels and levels after the intervention also did not differ significantly between these two subgroups (P > 0.1). The mean αGST differences were statistically elevated in men by 2.15 ng/mL compared to women when adjusted for BMI, duration of anesthesia, number of times anesthesia was administered previously and length of hospital stay. No significant difference was observed between patients who received desflurane and those who received regional anesthesia at any time point.

CONCLUSION: There was no difference in CYP2E1 IgG4 or αGST levels after desflurane exposure; further research is required to investigate their role in desflurane-induced liver injury.

Keywords: Drug-induced-liver injury, Desflurane, Anesthesia, Hepatotoxicity, CYP2E1 IgG4

Core tip: Several case reports of hepatotoxicity following anesthesia with desflurane have been published in the literature, implicating cytochrome P450 2E1-IgG4 autoantibodies. This study investigates the possible changes in CYP2E1 IgG4 autoantibody levels and other biochemical markers of liver injury in 40 adult patients who received anesthesia with desflurane for elective surgery. Samples were obtained before and 96 h after exposure to desflurane, and no significant difference was observed in levels of CYP2E1 IgG4, a-glutamyl-S-transferase, aspartate aminotransferase, alanine aminotransferase, g-glutamyl-transpeptidase or alkaline phosphatase levels, regardless of patients’ previous exposure to volatile anesthetics.