Artikel
Preoperative Total Bilirubin Ameliorates Hepatic Reperfusion Injury in Living Donation Liver Transplantation
Suche in Medline nach
Autoren
Veröffentlicht: | 24. April 2015 |
---|
Gliederung
Text
Introduction: It has been demonstrated in animal models that Heme Oxygenase-1 and its products biliverdin/bilirubin and carbon-monoxide protect against ischemia reperfusion injury (IRI). We investigated if increased bilirubin values in transplant recipients prior to liver transplantation decreases post-transplant reperfusion injury.
Material and methods: Preoperative total bilirubin levels were correlated to the postoperative rise in liver transaminase as marker of IRI. Additionally, living donor liver transplant recipients with pre transplant bilirubin levels >24 µmol/l (n=348) and ≤24 µmol/l (n=118) were compared (25th percentile of all pre-operative bilirubin values). Post-transplant liver function, complications, length of hospital and ICU stay, as well as patient and graft survival were compared.
Results: Preoperative total bilirubin levels were negatively correlated to the postoperative increase in liver transaminases suggesting a protective effect against IRI. The maximal absolute rise of AST within 48hrs after transplantation in high vs low bilirubin patients was 349 [-42-2802] vs. 443.5 [-46-2585] U/L U/L, P=0.006. The MELD score and its individual components as a marker of the severity of chronic liver disease were significantly higher in the high vs low bilirubin group (P<0.001). Despite this, no difference was observed in the postoperative complication rate (21.0% vs 21.2%; P=0.88), length of ICU stay (1 [0-159] days vs 1 [0-29] days, P=0.68), and hospital stay (13 [4-260] vs 14 [6-313] days; P=0.93). The 1-year graft survival was similar between high and low bilirubin patients (1-year: 90.8 % vs 89.0 %; P=0.62).
Conclusion: High bilirubin levels of liver recipient before transplantation ameliorates IRI after transplantation. Clinical outcome of transplant recipients with high vs low bilirubin levels is similar, despite increased MELD score.