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Preoperative 5-aminolevulinic acid administration for brain tumor surgery is associated with an increase in postoperative liver enzymes: a retrospective cohort study

  • Original Article - Brain Tumors
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Abstract

Background

Besides 5-aminolevulinic acid (5-ALA), liver enzyme elevation after brain tumor surgery can be caused by anesthesia and medications. In this retrospective study, we determined whether preoperative 5-ALA administration is associated with postoperative elevation of liver enzymes (PELE) in brain tumor patients and identified predictive factors for PELE in patients treated with 5-ALA.

Methods

In 179 patients undergoing brain tumor surgery with preoperative normal values of liver enzymes, laboratory data on serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and total bilirubin (T.bil) levels were collected preoperatively and through postoperative day (POD) 45.

Results

Ninety-nine PELEs (ALT, 56; AST, 34; ALP, 5; and TB, 4) were observed in 62 (34.6%) patients. Four (4.2%) patients treated with 5-ALA showed grade 3 elevation of transaminases based on the Common Terminology Criteria for Adverse Effects. Preoperative 5-ALA treatment was predictive of PELE (odds ratio [95% confidence interval], 2.30 [1.14–4.67]; P = 0.021). In patients treated with 5-ALA (n = 95), 70 PELEs (ALT, 39; AST, 22; ALP, 5; and TB, 4) were observed in 41 (43.2%) patients and significant predictive factors for PELE were preoperative ALT level (1.10 [1.04–1.17]; P = 0.001) and body mass index (BMI, 1.29 [1.08–1.56]; P = 0.006). In patients treated with 5-ALA, 13 and 36 patients, of 39 patients whose maximum postoperative ALT levels > 40 U/L, showed the normal value of serum ALT on PODs 14 and 45, respectively. Only three patients showed ALT elevation > 40 U/L on PODs 15–45, with a downward trend.

Conclusions

The use of 5-ALA for brain tumor surgery in patients with preoperative normal values of liver enzymes was associated with increased transient PELE, but a low incidence of severely elevated liver transaminases levels. When 5-ALA is administered to patients with the upper normal value of preoperative serum ALT and overweight, attention is paid to PELE.

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Funding

Seoul National University Bundang Hospital provided financial support in the form of academic funding (grant number: 02-2014-033).

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea

    Jun-Hyun Kim

  2. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

    Hyun-Kyu Yoon, Hyung-Chul Lee & Hee-Pyoung Park

  3. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

    Chul-Kee Park

  4. Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea

    Yun-Sik Dho

  5. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-2 Gumi-ro, Bundang-gu, Seongnam, 13620, South Korea

    Jung-Won Hwang

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  1. Jun-Hyun Kim
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Corresponding author

Correspondence to Jung-Won Hwang.

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The sponsor had no role in the design or conduct of this research.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This retrospective study was conducted after approval from the Institutional Review Board of Seoul National University Hospital (IRB no. 1811-078-985). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Because this was a retrospective study, for this type of study formal consent is not required.

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This article does not contain any studies with human participants performed by any of the authors.

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Comments

A study that once more demonstrated the safety of using 5-ALA as adjunct for malignant brain tumor surgery with regards to the medical influence of the substance. Still the most dangerous is to have the tumor and transient elevation of liver enzymes are of less relevance.

Jane Skjoth-Rasmussen

Copenhagen, Denmark

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This article is part of the Topical Collection on Brain Tumors

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Kim, JH., Yoon, HK., Lee, HC. et al. Preoperative 5-aminolevulinic acid administration for brain tumor surgery is associated with an increase in postoperative liver enzymes: a retrospective cohort study. Acta Neurochir 161, 2289–2298 (2019). https://doi.org/10.1007/s00701-019-04053-6

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  • DOI: https://doi.org/10.1007/s00701-019-04053-6

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