title: High preoperative bilirubin values protect against reperfusion injury after live donor liver transplantation.
abstract: Heme Oxygenase-1 and its product biliverdin/bilirubin have been demonstrated to protect against ischemia/reperfusion injury (IRI). We investigated whether increased preoperative bilirubin values of transplant recipients decrease IRI. Preoperative bilirubin levels of live donor liver recipients were correlated to postoperative liver transaminase as a marker of IRI. Additionally, two recipient groups with pretransplant bilirubin levels >24 μmol/l (n = 348) and ≤24 μmol/l (n = 118) were compared. Post-transplant liver function, complications, length of hospital stay, and patient and graft survival were assessed. Preoperative bilirubin levels were negatively correlated to the postoperative increase in transaminases suggesting a protective effect against IRI. The maximal rise of ALT after transplantation in high versus low bilirubin patients was 288 (-210-2457) U/l vs. 375 (-11-2102) U/l, P = 0.006. Bilirubin remained a significant determining factor in a multivariate linear regression analysis. The MELD score and its individual components as a marker of severity of chronic liver disease were significantly higher in the high versus low bilirubin group (P < 0.001). Despite this, overall complication rate (21.0% vs. 21.2%, P = 0.88), hospital stay [13 (4-260) vs. 14 (6-313) days, P = 0.93), and 1-year graft survival (90.8% vs. 89.0%, P = 0.62) were similar in both groups. High bilirubin levels of liver recipients before live donor transplantation is associated with decreased postoperative IRI.
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Vinzent N
authors.initials: VN
authors.lastname: Spetzler
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Goldaracena
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Johann M
authors.initials: JM
authors.lastname: Kaths
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Max
authors.initials: M
authors.lastname: Marquez
authors.affiliation: Department of Medicine, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Nazia
authors.initials: N
authors.lastname: Selzner
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cattral
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Greig
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Les
authors.initials: L
authors.lastname: Lilly
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Ian D
authors.initials: ID
authors.lastname: McGilvray
authors.affiliation: Department of Medicine, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Levy
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Anand
authors.initials: A
authors.lastname: Ghanekar
authors.affiliation: Department of Medicine, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Eberhard L
authors.initials: EL
authors.lastname: Renner
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: David R
authors.initials: DR
authors.lastname: Grant
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Markus
authors.initials: M
authors.lastname: Selzner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood*; D015992:Body Mass Index; D015209:Cholangitis, Sclerosing / Q000097:blood / Q000601:surgery; D005260:Female; D006085:Graft Survival; D051547:Heme Oxygenase-1 / Q000378:metabolism; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000097:blood / Q000601:surgery; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D015427:Reperfusion Injury / Q000097:blood*; D012107:Research Design; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C496541:HMOX1 protein, human; D051547:Heme Oxygenase-1; D001663:Bilirubin
keywords: bilirubin; biliverdin; heme oxygenase-1; ischemia-reperfusion injury; live donor liver transplantation