DAILY DETERMINATION OF INDIVIDUAL SERUM BILE-ACIDS ALLOWS EARLY DETECTION OF HEPATIC ALLOGRAFT DYSFUNCTION

Acute graft rejection is still a major cause of morbidity after orthot opic liver transplantation, and its diagnosis necessitates an invasive liver biopsy. Our aim has been to determine whether changes in indivi dual serum bile acid levels after engraftment are sensitive, specific and reliable indicators of graft function and whether these changes ca n antedate other biochemical indicators of hepatic allograft rejection . Individual bile acids in 200 serum samples taken serially from eight adult liver transplant patients were measured. Patients with biopsy-c ofirmed graft dysfunction due to rejection or nonrejection causes (n = 6 episodes) had significantly higher serum concentrations of glycocho late plus glycochenodeoxycholate and taurocholate/taurochenodeoxychola te ratios than did noncomplicated grafts (n = 3). These changes anteda ted any other conventional biochemical parameters' by at least 48 hr a nd were 100% sensitive and specific. None of the conventional liver fu nction tests could match this. Acute rejection episodes (n = 3) were t hen compared with nonrejection causes of graft dysfunction (n = 3). In acute rejection we noted a significant increase in the concentration of glycodeoxycholate plus deoxy cholate and a significant decrease in the cholate/chenodeoxycholate ratio compared with that in nonrejection graft malfunction. Both of these changes antedated any other biochemi cal parameters by 24 hr. In conclusion, individual serum bile acid ass ays, after orthotopic liver transplantation, can detect graft dysfunct ion resulting from any cause at an earlier time than routine biochemic al tests, and they are sensitive, specific and reliable for early dete ction of graft dysfunction. In addition, acute rejection can be distin guished from other causes of graft dysfunction.