Postoperative peak transaminases correlate with morbidity and mortality after liver resection.
Transaminase levels are usually measured as markers of hepatocellular injury following liver resection, but recent evidence was unclear on their clinical value. This study aimed to identify factors that determine peak postoperative transaminase levels and correlated transaminase levels to postoperative complications.



All liver resections performed at a single center between 2006 and 2015 were included in the analysis. Multivariate analysis was used to identify factors that determine peak ALT and AST levels and postoperative morbidity and mortality. An ALT and AST cutoff for the prediction of mortality was determined using receiver operating characteristic curves analysis.



A total of 539 resections were included. Clavien-Dindo grade III or higher complications, intraoperative transfusion, and operative duration were identified as determinants of peak transaminases. A peak AST cut-off value for predicting mortality was defined at 828 U/L, with an area under the curve of 0.81 (0.73-0.89). The cut-off was an independent predictor of mortality (P < 0.01) along with (intraoperative) transfusion (P < 0.01), fifty-fifty criteria (P < 0.01), and age (P < 0.01).



Postoperative transaminase levels are independent predictors of postoperative morbidity and mortality and therefore clinically relevant. Transaminase levels usually peak during the first 24 h after surgery and thus possess early prognostic power in terms of postoperative mortality.
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: p.b.olthof@amc.nl.
Pim B
PB
Olthof
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Joost
J
Huiskens
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Niek R
NR
Schulte
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Dennis A
DA
Wicherts
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Marc G
MG
Besselink
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Olivier R
OR
Busch
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Michal
M
Heger
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Thomas M
TM
van Gulik
D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion / Q000401:mortality; D004796:Clinical Enzyme Tests; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D016014:Linear Models; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D061646:Operative Time; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome; D015854:Up-Regulation
D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase