title: Pretransplant Serum Hyaluronic Acid Can Be a Biomarker as a Prognostic Predictor in Adult-to-Adult Living Donor Liver Transplantation.
abstract: OBJECTIVE
  The goal of this study was to evaluate whether pretransplant serum hyaluronic acid (HA) levels can predict outcomes after adult-to-adult living donor liver transplantation (LDLT).
  
  
  METHODS
  In study I, 21 patients who underwent LDLT (March 2002-February 2004) were divided into 2 groups: the H-I group (HA ≥500 ng/mL; n = 12) and the L-I group (HA <500 ng/mL; n = 9). The influence of pretransplantation HA levels on short-term surgical outcome was investigated. In study II, 77 LDLT patients (May 2004-December 2014) were also divided into 2 groups: the H-II group (HA ≥500 ng/mL; n = 40) and the L-II group (HA <500 ng/mL; n = 37). We compared long-term survival and investigated prognostic factors.
  
  
  RESULTS
  In study I, HA levels significantly decreased after LDLT, and those in the H-I group were significantly higher compared with the L-I group at 1, 3, 5, and 7 days after LDLT. There were significant differences in postoperative peak total bilirubin levels (H-I vs L-I, 17.2 vs 6.2 mg/dL; P = .013), peak ascitic fluid volume (1327 vs 697 mL/d; P = .005), and the hepatocyte growth factor levels at 3 days after LDLT (1879 vs 1092 pg/mL; P = .03). In study II, the 1- and 5-year survival rates were significantly lower in the H-II group than in the L-II group (H-II vs L-II, 65.0% and 48.5% vs 86.5% and 80.8%; P = .004). In multivariate analysis, significant prognostic factors were preoperative HA ≥500 ng/mL (P = .004) and graft to recipient body weight ratio <0.8 (P = .042).
  
  
  CONCLUSIONS
  Preoperative HA level can be a prognostic risk factor. Patients with high HA levels are vulnerable and should be carefully managed after LDLT.
authors.affiliation: Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan. Electronic address: mizunos@clin.medic.mie-u.ac.jp.
authors.forename: S
authors.initials: S
authors.lastname: Mizuno
authors.affiliation: Hepatobiliary Pancreatic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
authors.forename: B C
authors.initials: BC
authors.lastname: Das
authors.affiliation: Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Iizawa
authors.affiliation: Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kato
authors.affiliation: Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Murata
authors.affiliation: Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Tanemura
authors.affiliation: Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Kuriyama
authors.affiliation: Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Azumi
authors.affiliation: Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kishiwada
authors.affiliation: Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Usui
authors.affiliation: Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sakurai
authors.affiliation: Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Isaji
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D005260:Female; D006085:Graft Survival; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006820:Hyaluronic Acid