BACKGROUND: The increase in plasma aspartate (AST) and alanine (ALT) aminotransferase after liver resection is multifactorial, and a major problem is the difficult quantification of the impact of each factor involved. METHODS: Regression analysis of a large series of measurements for 92 hepatectomy patients was carried out to assess in detail the postoperative evolution of AST and ALT, together with related components. RESULTS: The best correlate of increased AST and ALT on postoperative day 1 was the duration of surgery (T-surg) (r(2)=0.31 and 0.29), with a lower correlation for intraoperative liver ischemia (T-isch) (r(2)=0.22 and 0.17, respectively; p<0.001 for all). Subsequently AST decreased more quickly than ALT and both followed an inverse exponential pattern. T-surg, T-isch, time after surgery and plasma bilirubin explained 77% and 51% of the variability of AST and ALT, respectively, for all postoperative measurements (p<0.001 for both). The best correlate of T-isch was a delayed increase in bilirubin, detected on postoperative day 7, attenuated by the use of intermittent liver ischemia. CONCLUSIONS: These data show that T-isch may not be the main determinant of increased transaminases after hepatectomy, and provide a quantitative analysis of the main impact of the trauma of liver resection, liver ischemia, and other factors on the postoperative evolution of transaminases.
BACKGROUND: The increase in plasma aspartate (AST) and alanine (ALT) aminotransferase after liver resection is multifactorial, and a major problem is the difficult quantification of the impact of each factor involved. METHODS: Regression analysis of a large series of measurements for 92 hepatectomy patients was carried out to assess in detail the postoperative evolution of AST and ALT, together with related components. RESULTS: The best correlate of increased AST and ALT on postoperative day 1 was the duration of surgery (T-surg) (r(2)=0.31 and 0.29), with a lower correlation for intraoperative liver ischemia (T-isch) (r(2)=0.22 and 0.17, respectively; p<0.001 for all). Subsequently AST decreased more quickly than ALT and both followed an inverse exponential pattern. T-surg, T-isch, time after surgery and plasma bilirubin explained 77% and 51% of the variability of AST and ALT, respectively, for all postoperative measurements (p<0.001 for both). The best correlate of T-isch was a delayed increase in bilirubin, detected on postoperative day 7, attenuated by the use of intermittent liver ischemia. CONCLUSIONS: These data show that T-isch may not be the main determinant of increased transaminases after hepatectomy, and provide a quantitative analysis of the main impact of the trauma of liver resection, liver ischemia, and other factors on the postoperative evolution of transaminases.
Authors: Pim B Olthof; Joost Huiskens; Niek R Schulte; Dennis A Wicherts; Marc G Besselink; Olivier R Busch; Michal Heger; Thomas M van Gulik Journal: HPB (Oxford) Date: 2016-09-02 Impact factor: 3.647
Authors: Carlo Chiarla; Ivo Giovannini; Francesco Ardito; Maria Vellone; Gennaro Nuzzo; Felice Giuliante Journal: Crit Care Date: 2014-03-25 Impact factor: 9.097