Elsevier

Transplantation Proceedings

Volume 55, Issue 1, January–February 2023, Pages 184-190
Transplantation Proceedings

Assessment of serum and drain fluid bilirubin concentrations in liver transplantation patients

https://doi.org/10.1016/j.transproceed.2022.11.003Get rights and content

ABSTRACT

Background

Bile leakage is a major complication after liver transplantation and remains as a significant source of morbidity and mortality. In 2011, the International Study Group of Liver Surgery (ISGLS) defined bile leakage as a drain/serum bilirubin ratio ≥3. However, to our knowledge there is no literature assessing serum and drain bilirubin concentrations after liver transplantation. The aim of this study was to describe the natural postoperative changes in serum and drain fluid bilirubin concentrations in patients after liver transplantation.

Methods

We included 32 patients who underwent liver transplantation at Kobe University Hospital from January 2007 to December 2020. We enrolled 34 living donors who had no complications as the control group.

Results

The recipient serum total/direct bilirubin concentration were higher compared with the donors from postoperative day (POD) 1 to 5 with a statistical difference (P < .05). The recipient drain/serum total bilirubin ratio was lower than donors on POD 3 (0.89 ± 0.07 vs 1.53 ± 0.07: P < .0001), which was also confirmed by the recipient drain/serum direct bilirubin ratio (0.64 ± 0.10 vs 1.18 ± 0.09: P < .0001). On POD 3, the drain fluid volume (647.38 ± 89.47 vs 113.43 ± 86.8 mL: P < .001) and serum total bilirubin concentration (6.73 ± 0.61 vs 1.23 ± 0.60 mg/dL: P < .001) was higher in the recipients than in donors. Categorized in 2 groups, the higher drain fluid volume and bilirubin concentration recipients showed lower drain/serum total bilirubin ratio compared with the other group (P = .03)

Conclusion

The drain/serum bilirubin ratio in the transplanted patients could be calculated lower compared with the hepatectomy patients because of high drain fluid volume and hyperbilirubinemia. Great care should be taken when assessing the bile leakage in liver transplant recipients using the ISGLS definition.

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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