The significance of measuring the serum total bile acids levels during orthotopic liver transplantation

BACKGROUND/AIMS: Bile acid is confined to the enterohepatic circulation and consists of intestinal absorption and hepatic elimination. We investigated whether measuring the serum total bile acids (TBA) levels was useful for b oth evaluating the function of the grafted liver and predicting the outcome in porcine orthotopic liver transplantation (OLT). METHODOLOGY: Twenty-two female Yorkshire pigs undergoing OLT were divided i nto 2 groups as follows: Group A consisted of 11 pigs which survived over 7 days with an uneventful early postoperative course, while Group B consiste d of 11 pigs which died within 5 days due to hepatic failure. The serum TBA levels were measured before and after reperfusion in the recipients. RESULTS: Between Groups A and B, no significant difference was observed in the operative backgrounds including the operation time as well as the cold and warm ischemic time. In Group A, the levels of serum TBA rapidly increas ed during the anhepatic phase, and thereafter promptly decreased after the reperfusion of the grafted liver. A significant difference was observed in the levels of serum TBA before and after reperfusion (p<0.01), whereas no s ignificant difference was seen in Group B. The Delta TBA, which represents the difference in the levels of serum TBA between just prior to reperfusion and 10min after reperfusion, was 71.8+/-43.5 mu mol/L in Group A and 20.1/-34.5 mu mol/L in Group B, and demonstrated a significant difference betwe en these 2 groups (p<0.01). On the other hand, no significant differences w ere seen in the levels of serum AST, ALT, ALP and TB at each time point bet ween Groups A and B. CONCLUSIONS: The level of serum TEA was found to be a more sensitive parame ter and also reflected the developing grafted Liver function earlier than t he conventional parameters for liver function. Moreover, a TBA thus appeare d to be a valuable predictor for the post-operative outcome.