CHOLIC-ACID SYNTHESIS IS REDUCED IN PEDIATRIC LIVER RECIPIENTS DURINGGRAFT DYSFUNCTION DUE TO ISCHEMIC-INJURY AND ALLOGRAFT-REJECTION

Background. Bile acids are synthesized and secreted by the liver, Duri ng liver failure and hepatic dysfunction, a marked reduction of bile a cid synthesis has been shown. The purpose of this study was to determi ne whether the biliary bile acid pattern was affected by preservation injury and rejection and whether it was a reliable marker for graft fu nction in pediatric liver recipients after liver transplantation. Meth ods, We prospectively measured the biliary bile acid pattern in 126 se rial bile samples obtained from 15 consecutive pediatric liver recipie nts by reversed phase high pressure liquid chromatography and correlat ed our results with clinical findings: preservation injury, no rejecti on, rejection, or infection,Results, There was a significant change of the bile acid pattern during the first 3 days after transplant, Total biliary bile acids, cholic acid (CA), and CA/chenodeoxycholic acid (C DCA) ratio increased in 12 of 15 patients with mild preservation injur y, These changes of the bile acid pattern were markedly delayed in pat ients with severe preservation injury, During 16 rejection episodes, t otal biliary bile acid, CA, and CAI CDCA ratio decreased significantly , but returned to normal after successful treatment of rejection, Bact erial infection, observed in nine children, and cyclosporine toxicity, observed in three children, seemed to have no affect on the biliary b ile acids, Conclusions, Liver cell damage as a result of preservation injury or rejection leads to a reduction of biliary CA, resulting in a decrease of total biliary bile acids and the CA/CDCA ratio in pediatr ic liver recipients, This might be caused by a diminished secretion of bile acids and by a decreased synthesis of bile acids.