title: Hepatic steatosis is associated with intrahepatic cholestasis and transient hyperbilirubinemia during regeneration after living donor liver transplantation.
abstract: 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.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jai Young
authors.initials: JY
authors.lastname: Cho
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
authors.forename: Hae Won
authors.initials: HW
authors.lastname: Lee
authors.forename: Eung-Ho
authors.initials: EH
authors.lastname: Cho
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Yang
authors.forename: Yong Beom
authors.initials: YB
authors.lastname: Cho
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Min A
authors.initials: MA
authors.lastname: Kim
authors.forename: Ja-June
authors.initials: JJ
authors.lastname: Jang
authors.forename: Kuhn Uk
authors.initials: KU
authors.lastname: Lee
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents; D019394:Ki-67 Antigen; D018809:Proliferating Cell Nuclear Antigen