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. 2023 Jul 13;23(1):237.
doi: 10.1186/s12876-023-02744-0.

Neutrophil extracellular traps predict postoperative pulmonary complications in paediatric patients undergoing parental liver transplantation

Yaling Liu #  1   2 , Huigang Shu #  2 , Ping Wan  3 , Xiaodong Wang  4 , Hong Xie  5
Affiliations

Neutrophil extracellular traps predict postoperative pulmonary complications in paediatric patients undergoing parental liver transplantation

Yaling Liu et al. BMC Gastroenterol. .

Abstract

Background: Parental liver transplantation (PLT) improves long-term survival rates in paediatric hepatic failure patients; however, the mechanism of PLT-induced postoperative pulmonary complications (PPCs) is unclear.

Methods: A total of 133 paediatric patients undergoing PLT were included. Serum levels of NET components, including circulating free DNA (cfDNA), DNA-histone complex, and myeloperoxidase (MPO)-DNA complex, were detected. The occurrence of PPCs post-PLT, prolonged intensive care unit (ICU) stay and death within one year were recorded as the primary and secondary outcomes.

Results: The overall rate of PPCs in the hospital was 47.4%. High levels of serum cfDNA, DNA-histone complexes and MPO-DNA complexes were associated with an increased risk of PPCs (for cfDNA, OR 2.24; for DNA-histone complex, OR 1.64; and for MPO-DNA, OR 1.94), prolonged ICU stay (OR 1.98, 4.26 and 3.69, respectively), and death within one year (OR 1.53, 2.65 and 1.85, respectively). The area under the curve of NET components for the prediction of PPCs was 0.843 for cfDNA, 0.813 for DNA-histone complexes, and 0.906 for MPO-DNA complexes. During the one-year follow-up, the death rate was higher in patients with PPCs than in patients without PPCs (14.3% vs. 2.9%, P = 0.001).

Conclusions: High serum levels of NET components are associated with an increased incidence of PPCs and death within one year in paediatric patients undergoing PLT. Serum levels of NET components serve as a biomarker for post-PLT PPCs and a prognostic indicator.

Keywords: Paediatric; Parental liver transplantation; Postoperative pulmonary complication.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study design of the present study
Fig. 2
Fig. 2
Serum levels of NET components in patients with or without PPCs. Serum levels of the NET components cfDNA, DNA-histone complexes, and MPO-DNA complexes in healthy controls and PLT patients with or without PPCs. The levels both pre-PLT and 24 h post-PLT were measured. Data are the mean ± SD, expressed relative to healthy controls. ** p < 0.01. One-way ANOVA with Bonferroni post hoc analysis. NET, neutrophil extracellular trap; cfDNA, circulating free DNA; MPO, myeloperoxidase; PLT, parental liver transplantation; PPCs: postoperative pulmonary complications.
Fig. 3
Fig. 3
Receiver operating characteristic curve analysis of NET components on PPCs. Receiver operating characteristic (ROC) curve analysis of post-PLT serum NET components with the occurrence of PPCs. The sensitivity, specificity, and area under the curve (AUC) were analysed for cfDNA, DNA-histone complexes and MPO-DNA complexes
Fig. 4
Fig. 4
PMA-induced NET formation in vitro. cfDNA, MPO and citrullinated histone 3 were significantly formed in the serum of ALI/ARDS patients compared to the control. After PMA stimulation, these components of NETs increased significantly
Fig. 5
Fig. 5
Survival analysis within one year post-PLT. Kaplan‒Meier survival curves during the one-year follow-up based on stratified serum levels of NET components: (A) cfDNA, (B) DNA-histone complex, and (C) MPO-DNA complex
See this image and copyright information in PMC

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