EARLY DETECTION OF GRAFT DYSFUNCTION AFTER ORTHOTOPIC LIVER-TRANSPLANTATION IN MAN BY SERUM AND BILIARY BILE-ACID ANALYSIS

Background/Aims: Several routine parameters are used to monitor the fu nctional state of the Liver after orthotopic liver transplantation (OL T). These parameters may not fully mirror hepatic function and even li ver biopsy may be unreliable during onset of graft rejection. Addition al analytical methods on bile constituents for recognition of early gr aft dysfunction have been assessed. Conflicting results have prompted discussions about the usefulness of monitoring serum bile acids and bi liary Lipids after OLT with respect to early recognition of graft dysf unction. Materials and Methods: Routine serum Liver function, tests we re compared with serum bile acid (BA) concentrations and output of bil iary lipids (BA, phospholipids, cholesterol) over 20-25 days in 12 pat ients after (OLT) with different postoperative courses. Results: 4 pat ients had an uneventful postoperative course (group 1); 5 experienced a rejection episode (group 2); 3 demonstrated a poor initial graft fun ction (group 3). In group 1 aspartate-aminotransferase (AST) (<20 U/L) , urinary BA excretion (<21 mmoles/day) and normalized bile flow (NBF; 72+/-25 ml bile/mmole BA) fell into the normal range within 4 days af ter OLT; serum BA concentration (<20 mM) was within normal on, the fir st postoperative day. Output of biliary BA, phospholipids, cholesterol and bile production increased continuously during the observation per iod reaching values of 11.2+/-3.3 mmoles/day, 2.7+/-0.9 mmoles/day, 1. 3+/-0.5 mmoles/day and 761+/-221 ml/day, respectively. The ratio of ta urocholate/glycocholate (TC/GC) decreased from an initial value of 0.4 5 to 0.11. Group 2 yielded similar values until rejection appeared. At this time serum BA concentration, NBF,urinary BA excretion and TC/GC- ratio rose; biliary lipid output and bile flow decreased. In most of t he patients these changes occurred at the same day or 1-3 days earlier than, that of AST. Conclusions: The determination of serum BA concent ration, TC/GC-ratio, output of biliary lipids and NBF may indicate gra ft dysfunction 1-3 days earlier than. AST and, thus, may provide usefu l parameters for early recognition of liver graft dysfunction.