Assessment of serum and drain fluid bilirubin concentrations in liver transplantation patients
Section snippets
Patients
This retrospective study was approved by the ethics committee of Kobe University Hospital. All procedures were conducted in accordance with the principles of the Declaration of Helsinki and its subsequent revisions. The recipients and donors who underwent liver transplantation at Kobe University Hospital from January 2007 to December 2020 were enrolled in the study. We excluded any patients who died after surgery, needed reoperation, or experienced bile leakage or abdominal hemorrhage.
Donor evaluation
Progression pattern of perioperative bilirubin concentration in the serum and drain after living donor hepatectomy and liver transplantation
Thirty-four living donors and 32 liver transplant recipients were enrolled in the study. Table 1 shows the baseline characteristics and perioperative bilirubin concentrations of the donors. The postoperative serum total bilirubin concentration reached the highest level on POD 1, decreasing gradually thereafter. The postoperative drain total bilirubin concentration ranged from 1.3 to 1.8 throughout POD 1 to 5. Table 2 shows the baseline characteristics and perioperative bilirubin concentrations
Discussion
In this study, we demonstrated that the drain/serum bilirubin ratio in liver transplant recipients is significantly lower compared with that in living donors—not because of the different drainage system, but because of the natural history of recipient postoperative massive ascites and hyperbilirubinemia. After hepatectomy or transplantation, abdominal drainage tubes are routinely inserted. Removal of the drainage tube is planned after the evaluation of the existence of bile leakage, which can
Conclusion
In the present study, we demonstrated for the first time that the drain/serum bilirubin ratio in transplanted patients is different from that of the ISGLS definition and could be calculated to be lower than that in hepatectomy patients. Greater care should be taken in assessing bile leakage among liver transplant recipients using the ISGLS definition because a lower drain/serum bilirubin ratio cannot sufficiently deny the existence of bile leakage.
DISCLOSURE
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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