U. Baumgartner et al., EARLY DETECTION OF GRAFT DYSFUNCTION AFTER ORTHOTOPIC LIVER-TRANSPLANTATION IN MAN BY SERUM AND BILIARY BILE-ACID ANALYSIS, Hepato-gastroenterology, 42(6), 1995, pp. 950-960
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.