title: Postoperative day one serum alanine aminotransferase does not predict patient morbidity and mortality after elective liver resection in non-cirrhotic patients.
abstract: Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase (ALT) correlate with patient outcome after liver resection. We assessed whether postoperative day 1 (POD 1) ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient's morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because of the low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.
authors.affiliation: Department of Hepato-pancreatico-biliary Surgery, University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK. Gabriele.Marangoni@uhcw.nhs.uk.
authors.forename: Ricky Harminder
authors.initials: RH
authors.lastname: Bhogal
authors.forename: Amit
authors.initials: A
authors.lastname: Nair
authors.forename: Davide
authors.initials: D
authors.lastname: Papis
authors.forename: Zaed
authors.initials: Z
authors.lastname: Hamady
authors.forename: Jawad
authors.initials: J
authors.lastname: Ahmad
authors.forename: For Tai
authors.initials: FT
authors.lastname: Lam
authors.forename: Saboor
authors.initials: S
authors.lastname: Khan
authors.forename: Gabriele
authors.initials: G
authors.lastname: Marangoni
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D017115:Catheter Ablation / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D004739:England; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase