4.5 Article

High preoperative bilirubin values protect against reperfusion injury after live donor liver transplantation

Journal

TRANSPLANT INTERNATIONAL
Volume 28, Issue 11, Pages 1317-1325

Publisher

WILEY
DOI: 10.1111/tri.12634

Keywords

bilirubin; biliverdin; heme oxygenase-1; ischemia-reperfusion injury; live donor liver transplantation

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Heme Oxygenase-1 and its product biliverdin/bilirubin have been demonstrated to protect against ischemia/reperfusion injury (IRI). We investigated whether increased preoperative bilirubin values of transplant recipients decrease IRI. Preoperative bilirubin levels of live donor liver recipients were correlated to postoperative liver transaminase as a marker of IRI. Additionally, two recipient groups with pretransplant bilirubin levels >24mol/l (n=348) and 24mol/l (n=118) were compared. Post-transplant liver function, complications, length of hospital stay, and patient and graft survival were assessed. Preoperative bilirubin levels were negatively correlated to the postoperative increase in transaminases suggesting a protective effect against IRI. The maximal rise of ALT after transplantation in high versus low bilirubin patients was 288 (-210-2457) U/l vs. 375 (-11-2102) U/l, P=0.006. Bilirubin remained a significant determining factor in a multivariate linear regression analysis. The MELD score and its individual components as a marker of severity of chronic liver disease were significantly higher in the high versus low bilirubin group (P<0.001). Despite this, overall complication rate (21.0% vs. 21.2%, P=0.88), hospital stay [13 (4-260) vs. 14 (6-313) days, P=0.93), and 1-year graft survival (90.8% vs. 89.0%, P=0.62) were similar in both groups. High bilirubin levels of liver recipients before live donor transplantation is associated with decreased postoperative IRI.

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