Short-term liver function after biliopancreatic diversion.
BACKGROUND
Liver failure after biliopancreatic diversion (BPD) has been reported. Although in our series of 2,515 BPD with a minimum follow-up of 12 months we have never observed this complication, a transitory and significant rise in serum AST and ALT has been detected in some cases, suggesting the occurrence of transient liver damage. To assess if risk factors for acute liver damage after BPD could be identified, we studied the evolution of hepatic biochemistry in a sample of our operated subjects.


METHODS
We studied 99 consecutive patients submitted to the same type of BPD (ad hoc stomach, ad hoc alimentary limb). Patients with a history of alcohol consumption or positive hepatic serology were excluded. Preoperative body weight (BW), body mass index (BMI), excess weight (EW), % excess weight (%EW), fasting serum glucose level (SG), hepatic histology (HI), weight loss (WL) at 2, 4 and 12 months, and excess weight % loss (IEW%L) at the same time were correlated with preoperative and 2, 4 and 12 months hepatic biochemistry.


RESULTS
Compared with preoperative values, AST levels at 2 months significantly increased (Student's t-test, P=0.0003) and significantly decreased at 12 months (P=0.0001). Spearman's Rank test showed significant correlations between 2 months AST levels and WL at 2 months (P =0.005), preoperative BW (P <0.0001), SG (P =0.01), and HI (inflammation P<0.0001, fibrosis P=0.001).


CONCLUSIONS
Hepatocellular necrosis in our series peaks at 2 months, and decreases afterwards.WL at 2 months, preoperative BW, SG and HI seem to be of help in identifying patients at increased risk for acute liver damage, prompting the need for an enhanced surveillance.
Papadia
Francesco
F
University of Genoa School of Medicine, Genoa, Italy. francescopapadia@yahoo.com
Marinari
Giuseppe M
GM
Camerini
Giovanni
G
Adami
Gian Franco
GF
Murelli
Federica
F
Carlini
Flavia
F
Stabilini
Cesare
C
Scopinaro
Nicola
N
D000293:Adolescent; D000328:Adult; D015904:Biliopancreatic Diversion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000503:physiopathology*; D017093:Liver Failure / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012307:Risk Factors