Recipient Hyperbilirubinemia May Reduce Ischemia-Reperfusion Injury but Fails to Improve Outcome in Clinical Liver Transplantation
Background. Exogenous bilirubin may reduce experimental ischemia-reperfusion injury (IRI) due to its antioxidant properties. We studied if early graft exposure to high bilirubin levels in the recipient affects the early IRI and outcomes after liver transplantation (LTx). Methods. In 427 LTx patients...
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2016/6964856 |
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| author | Mihai Oltean Christian Barrenäs Paulo Ney Martins Gustaf Herlenius Bengt Gustafsson Styrbjörn Friman William Bennet |
| author_facet | Mihai Oltean Christian Barrenäs Paulo Ney Martins Gustaf Herlenius Bengt Gustafsson Styrbjörn Friman William Bennet |
| author_sort | Mihai Oltean |
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| description | Background. Exogenous bilirubin may reduce experimental ischemia-reperfusion injury (IRI) due to its antioxidant properties. We studied if early graft exposure to high bilirubin levels in the recipient affects the early IRI and outcomes after liver transplantation (LTx). Methods. In 427 LTx patients, the AUROC curve based on bilirubin and AST at day 1 identified a cutoff of 2.04 mg/dL for the recipient pretransplant bilirubin. Recipients were grouped as having low (group L, n=152) or high (group H, n=275) bilirubin. Both groups had similar donor-related variables (age, preservation time, donor BMI > 28, and donor risk index (DRI)). Results. Alanine (ALT) and aspartate (AST) aminotransferase levels were higher in group L at day 1; ALT levels remained higher at day 2 in group L. LTx from high risk donors (DRI > 2) revealed a trend towards lower transaminases during the first two days after transplantation in group H. One month and 1-year patient survival were similar in groups L and H. High preoperative bilirubin did not affect the risk for early graft dysfunction (EGD), death, or graft loss during the first year after transplantation nor the incidence of acute rejection. LTx using donors with DRI > 2 resulted in similar rates of EGD in both groups. Conclusion. Increased bilirubin appears to reduce the early IRI after LTx yet this improvement was insufficient to improve the clinical outcome. |
| format | Article |
| id | doaj-art-3dc12262f236417093b090f6db695c81 |
| institution | Kabale University |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
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| series | Gastroenterology Research and Practice |
| spelling | doaj-art-3dc12262f236417093b090f6db695c812025-02-03T01:10:52ZengWileyGastroenterology Research and Practice1687-61211687-630X2016-01-01201610.1155/2016/69648566964856Recipient Hyperbilirubinemia May Reduce Ischemia-Reperfusion Injury but Fails to Improve Outcome in Clinical Liver TransplantationMihai Oltean0Christian Barrenäs1Paulo Ney Martins2Gustaf Herlenius3Bengt Gustafsson4Styrbjörn Friman5William Bennet6The Transplant Institute, Sahlgrenska University Hospital, 413 45 Gothenburg, SwedenSahlgrenska Academy, The University of Gothenburg, Gothenburg, SwedenDepartment of Surgery, Transplant Division, University of Massachusetts, Worcester, MA 01655, USAThe Transplant Institute, Sahlgrenska University Hospital, 413 45 Gothenburg, SwedenThe Transplant Institute, Sahlgrenska University Hospital, 413 45 Gothenburg, SwedenThe Transplant Institute, Sahlgrenska University Hospital, 413 45 Gothenburg, SwedenThe Transplant Institute, Sahlgrenska University Hospital, 413 45 Gothenburg, SwedenBackground. Exogenous bilirubin may reduce experimental ischemia-reperfusion injury (IRI) due to its antioxidant properties. We studied if early graft exposure to high bilirubin levels in the recipient affects the early IRI and outcomes after liver transplantation (LTx). Methods. In 427 LTx patients, the AUROC curve based on bilirubin and AST at day 1 identified a cutoff of 2.04 mg/dL for the recipient pretransplant bilirubin. Recipients were grouped as having low (group L, n=152) or high (group H, n=275) bilirubin. Both groups had similar donor-related variables (age, preservation time, donor BMI > 28, and donor risk index (DRI)). Results. Alanine (ALT) and aspartate (AST) aminotransferase levels were higher in group L at day 1; ALT levels remained higher at day 2 in group L. LTx from high risk donors (DRI > 2) revealed a trend towards lower transaminases during the first two days after transplantation in group H. One month and 1-year patient survival were similar in groups L and H. High preoperative bilirubin did not affect the risk for early graft dysfunction (EGD), death, or graft loss during the first year after transplantation nor the incidence of acute rejection. LTx using donors with DRI > 2 resulted in similar rates of EGD in both groups. Conclusion. Increased bilirubin appears to reduce the early IRI after LTx yet this improvement was insufficient to improve the clinical outcome.http://dx.doi.org/10.1155/2016/6964856 |
| spellingShingle | Mihai Oltean Christian Barrenäs Paulo Ney Martins Gustaf Herlenius Bengt Gustafsson Styrbjörn Friman William Bennet Recipient Hyperbilirubinemia May Reduce Ischemia-Reperfusion Injury but Fails to Improve Outcome in Clinical Liver Transplantation Gastroenterology Research and Practice |
| title | Recipient Hyperbilirubinemia May Reduce Ischemia-Reperfusion Injury but Fails to Improve Outcome in Clinical Liver Transplantation |
| title_full | Recipient Hyperbilirubinemia May Reduce Ischemia-Reperfusion Injury but Fails to Improve Outcome in Clinical Liver Transplantation |
| title_fullStr | Recipient Hyperbilirubinemia May Reduce Ischemia-Reperfusion Injury but Fails to Improve Outcome in Clinical Liver Transplantation |
| title_full_unstemmed | Recipient Hyperbilirubinemia May Reduce Ischemia-Reperfusion Injury but Fails to Improve Outcome in Clinical Liver Transplantation |
| title_short | Recipient Hyperbilirubinemia May Reduce Ischemia-Reperfusion Injury but Fails to Improve Outcome in Clinical Liver Transplantation |
| title_sort | recipient hyperbilirubinemia may reduce ischemia reperfusion injury but fails to improve outcome in clinical liver transplantation |
| url | http://dx.doi.org/10.1155/2016/6964856 |
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