Korean J Transplant.  2022 Nov;36(Supple 1):S27. 10.4285/ATW2022.F-1233.

Profile of serum total bile acid levels and their value in the evaluation of graft dysfunction in live donor liver transplant

• Sundararajan VB
• Kumar S
• Kilambi R
• Chattopadhyay TK

• KMID: 2535175
• DOI: http://doi.org/10.4285/ATW2022.F-1233

Abstract

Background
Early allograft dysfunction (EAD) in the immediate post liver transplant period is based on clinical criteria and laboratory values. Acute cellular rejection (ACR) is the prototype of graft dysfunction. The aims of this study were to study the profile of serum total bile acids (STBA) in the early posttransplant period in the living donor liver transplant (LDLT) setting and to explore their value in the diagnostic resolution of EAD especially in relation to ACR in liver recipients.
Methods
Consecutive patients who underwent LDLT form August, 2018 to December, 2019 were studied. STBA level was mea-sured preoperatively and from postoperative day 1 to 14. EAD was defined as per Olthoffs criteria. ACR was defined as doubling of liver enzymes AST/ALT (transaminitis) from previous in the absence of other causes that responded to steroid pulse or in-creasing immunosuppression.
Results
Of the 63 patients who underwent LDLT, EGD occurred in 25.4% and ACR in 26.9%. The median baseline STBA in cir-rhotic patients awaiting liver transplant was 95.1 mol/L (range, 15.5–578.6 mol/L). The STBA levels decrease to near normal values on postoperative day (POD) 1 and continue to plateau till POD 14. The mean value of POD 1 STBA was 30.5 (SD, 56.8) mol/L and on POD 14 was 35.7 (SD, 53.8) mol/L. The STBA levels were higher and with increasing trend in those with EAD from POD 3–14. STBAs increase before ACR 24–48 hours before the increase in liver enzymes. The sensitivity and specificity of STBA increase to predict ACR was 94.1% and 61.9% and the area under the receiver operating characteristic curve is 0.78 (95% CI, 0.653–0.877).
Conclusions
STBAs levels were higher and in increasing trend in the first postoperative week in those with EAD. STBAs increase from previous value may help to differentiate between ACR and sepsis.