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132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

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Preoperative Total Bilirubin Ameliorates Hepatic Reperfusion Injury in Living Donation Liver Transplantation

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  • Vinzent Spetzler - Universitätsklinikum Frankfurt, Allgemein- und Viszeralchirurgie, Frankfurt am Main, Deutschland
  • Nicolas Goldaracena - Toronto General Hospital, Multi Organ Transplant Program, Toronto, ON M5G 2N2, CA
  • Max Marquez - Toronto General Hospital, Multi Organ Transplant Program, Toronto, ON M5G 2N2, CA
  • Nazia Selzner - Toronto General Hospital, Multi Organ Transplant Program, Toronto, ON M5G 2N2, CA
  • Mark Cattral - Toronto General Hospital, Multi Organ Transplant Program, Toronto, ON M5G 2N2, CA
  • Paul Greig - Toronto General Hospital, Multi Organ Transplant Program, Toronto, ON M5G 2N2, CA
  • Les Lilly - Toronto General Hospital, Multi Organ Transplant Program, Toronto, ON M5G 2N2, CA
  • Ian McGilvray - Toronto General Hospital, Multi Organ Transplant Program, Toronto, ON M5G 2N2, CA
  • Gary Levy - Toronto General Hospital, Multi Organ Transplant Program, Toronto, ON M5G 2N2, CA
  • Anand Ghanekar - Toronto General Hospital, Multi Organ Transplant Program, Toronto, ON M5G 2N2, CA
  • Eberhard Renner - Toronto General Hospital, Multi Organ Transplant Program, Toronto, ON M5G 2N2, CA
  • David Grant - Toronto General Hospital, Multi Organ Transplant Program, Toronto, ON M5G 2N2, CA
  • Markus Selzner - Toronto General Hospital, Multi Organ Transplant Program, Toronto, ON M5G 2N2, CA

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch318

doi: 10.3205/15dgch318, urn:nbn:de:0183-15dgch3181

Published: April 24, 2015

© 2015 Spetzler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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.