Hepatic steatosis is associated with intrahepatic cholestasis and transient hyperbilirubinemia during regeneration after living donor liver transplantation.
A clear understanding of the mechanisms in steatotic livers that trigger cholestasis or hyperbilirubinemia after living donor liver transplantation (LDLT) remains elusive. We hypothesized that microarchitectural disturbance might occur within regenerating steatotic livers without impairment of hepatic proliferative activity. Liver biopsy specimens from 67 LDLT recipients taken at the 10th postoperative day were scored for the numbers of portal tracts per area (nPT/A) of liver tissue and for intrahepatic cholestasis, and immunostained by proliferating cell nuclear antigen (PCNA) and Ki-67. The preoperative degree of macrovesicular steatosis (MaS) was independently associated with cholestasis after LDLT (P < 0.001). Serum total bilirubin results on the 1st, 3rd, and 7th days post-LDLT in MaS+ (5-30% of MaS; n = 37) patients were significantly higher than those in MaS- (<5% of MaS; n = 30) patients (P = 0.030, 0.042, and 0.019, respectively). Mean numbers of positively stained hepatocytes were 53.1 +/- 12.0 in patients with MaS and 48.0 +/- 17.1 in those without MaS by PCNA (P = 0.390), and 24.4 +/- 10.5 and 24.0 +/- 14.0 by Ki-67 (P = 0.940). However, a significant negative correlation was found between the degree of MaS and nPT/A (P = 0.013), and nPT/A was correlated with the grade of histological cholestasis (r = 0.350, P = 0.039). Intrahepatic cholestasis and hyperbilirubinemia after LDLT could be caused by scanty morphologic change of portal tract during steatotic liver regeneration.
Cho
Jai Young
JY
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Suh
Kyung-Suk
KS
Lee
Hae Won
HW
Cho
Eung-Ho
EH
Yang
Sung Hoon
SH
Cho
Yong Beom
YB
Yi
Nam-Joon
NJ
Kim
Min A
MA
Jang
Ja-June
JJ
Lee
Kuhn Uk
KU
D000328:Adult; D001706:Biopsy; D002780:Cholestasis, Intrahepatic / Q000473:pathology*; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000473:pathology*; D007166:Immunosuppressive Agents / Q000494:pharmacology; D019394:Ki-67 Antigen / Q000096:biosynthesis; D008099:Liver / Q000473:pathology; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D018809:Proliferating Cell Nuclear Antigen / Q000096:biosynthesis
D007166:Immunosuppressive Agents; D019394:Ki-67 Antigen; D018809:Proliferating Cell Nuclear Antigen