title: Preoperative bile replacement improves immune function for jaundiced patients treated with external biliary drainage.
abstract: BACKGROUND
  Although preoperative biliary drainage in jaundiced patients is controversial, external biliary drainage (EBD) is beneficial for infection control in patients with biliary cancers. When EBD is performed, additional bile replacement (BR) has the benefit of improving impaired intestinal barrier function, but the detailed mechanism remains unknown. We examined the effect of bile replacement on immune functions over the duration of BR in jaundiced patients.
  
  
  METHODS
  Fifteen patients were enrolled into this prospective study. BR was started soon after the total serum bilirubin concentration reached 5.0 mg/dl and was continued for 14 days. Drained bile was given two times orally (2 × 100 ml/day). Concanavalin A (Con A)- and phytohemagglutinin (PHA)-stimulated lymphocyte proliferation and serum diamine oxidase (DAO) activity were measured before starting and during BR. Twenty patients with EBD and no BR were analyzed as a control group.
  
  
  RESULTS
  Serum liver enzymes, prothrombin time-international normalized ratio (PT-INR), and responses to Con A and PHA gradually improved over the 14 days of BR, but percentages of lymphocytes and DAO levels did not. PT-INR, and Con A and PHA responses did not improve during EBD in the control group. PT-INR significantly decreased in patients with a greater fraction of their drained bile replaced.
  
  
  CONCLUSIONS
  Our results indicate that preoperative BR using as large a quantity of bile as possible is useful for improving blood coagulability and cellular immunity in patients with EBD.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ajiki
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Ueno
authors.forename: Kenta
authors.initials: K
authors.lastname: Shinozaki
authors.forename: Sae
authors.initials: S
authors.lastname: Murakami
authors.forename: Taro
authors.initials: T
authors.lastname: Okazaki
authors.forename: Taku
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Ippei
authors.initials: I
authors.lastname: Matsumoto
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Usami
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile; D001663:Bilirubin / Q000097:blood; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007111:Immunity, Cellular; D041781:Jaundice, Obstructive / Q000097:blood / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D013601:T-Lymphocytes / Q000276:immunology*; D055815:Young Adult
chemical_list: D001663:Bilirubin