Biliary bile acid concentration is a simple and reliable indicator for liver function after hepatobiliary resection for biliary cancer.

BACKGROUND The functional recovery of the remnant liver after an extended hepatectomy is critical for the outcome of the patient. The aim of this prospective study was to examine whether biliary bile acids could be an indicator for postoperative liver function. METHODS Externally drained bile samples were obtained from 51 patients with biliary or periampullary carcinomas before and after surgery. Patients were categorized into 3 groups: group A, 29 hepatectomized patients without liver failure; group B, 7 hepatectomized patients with liver failure (maximum serum bilirubin level, >10 mg/dL); and group C, 15 patients who underwent biliopancreatic resection without hepatectomy, with a good postoperative course. Bile samples were withdrawn 1 day before surgery and on postoperative days 1, 2, 3, 4, 6, and 7. Total bile acids were measured with a 3 alpha-hydroxysteroid dehydrogenase method. RESULTS Before surgery, the concentration of bile acids was higher in groups A and C than in group B, and correlated significantly with the indocyamine green disappearance rate (KICG) values (R(2) = 0.557; P <.0001). After surgery, bile acid concentrations decreased in all 3 groups until postoperative day 2, which was followed by a gradual increase. The concentration recovered to the preoperative level in groups A and C but remained low in group B. Biliary bile acid concentrations on day 2 correlated significantly with remnant liver KICG values (R(2) = 0.257; P =.0019). Among several parameters studied, including KICG, remnant liver KICG, biliary bile acids, and biliary bilirubin, biliary bile acid concentration had the most predictive power for occurrence of postoperative liver failure. CONCLUSION Biliary bile acid concentration could be a simple, real-time, reliable indicator of preoperative and postoperative liver function.

[1]  Y. Takada,et al.  Radical resection of hilar bile duct carcinoma and predictors of survival , 2000, The British journal of surgery.

[2]  P. Meier,et al.  Differential expression of basolateral and canalicular organic anion transporters during regeneration of rat liver. , 1999, Gastroenterology.

[3]  W. Bechstein,et al.  Extended resections for hilar cholangiocarcinoma. , 1999, Annals of surgery.

[4]  M. Cuesta,et al.  Is major liver surgery associated with an increased systemic inflammatory response? A prospective comparison of hemihepatectomy and other major abdominal surgery. , 1999, Liver.

[5]  P. Jansen,et al.  Regulation of hepatic transport systems involved in bile secretion during liver regeneration in rats , 2018 .

[6]  J. Sakamoto,et al.  Blood loss and ICG clearance as best prognostic markers of post-hepatectomy liver failure. , 1999, Hepato-gastroenterology.

[7]  M. Nagino,et al.  Interleukin 6 in bile as an indicator of liver function after hepatectomy in patients with biliary tract carcinoma , 1999, The British journal of surgery.

[8]  G. Hooiveld,et al.  Up‐regulation of the multidrug resistance genes, Mrp1 and Mdr1b, and down‐regulation of the organic anion transporter, Mrp2, and the bile salt transporter, Spgp, in endotoxemic rat liver , 1998, Hepatology.

[9]  M. Nagino,et al.  Aggressive surgical treatment of hilar cholangiocarcinoma. , 1998, Journal of hepato-biliary-pancreatic surgery.

[10]  M. Nagino,et al.  Human hepatocyte growth factor in bile: An indicator of posthepatectomy liver function in patients with biliary tract carcinoma , 1997, Hepatology.

[11]  K. Man,et al.  Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy , 1997, The British journal of surgery.

[12]  Y. Nakajima,et al.  Efficacy and safety of preoperative percutaneous transhepatic portal embolization with absolute ethanol: a clinical study. , 1997, Surgery.

[13]  T. Baère,et al.  Preoperative portal vein embolization for extension of hepatectomy indications , 1996, Hepatology.

[14]  M. Nagino,et al.  Selective percutaneous transhepatic embolization of the portal vein in preparation for extensive liver resection: the ipsilateral approach. , 1996, Radiology.

[15]  D. Beier,et al.  Regulation of hepatocyte bile salt transporters by endotoxin and inflammatory cytokines in rodents. , 1996, Gastroenterology.

[16]  S. Erlinger.  Review Article: New insights into the mechanisms of hepatic transport and bile secretion , 1996, Journal of gastroenterology and hepatology.

[17]  R. Rai,et al.  Review: Regulation of liver regeneration by pro‐inflammatory cytokines , 1996, Journal of gastroenterology and hepatology.

[18]  M. Miyaji,et al.  Comparative studies on bile flow and biliary lipid excretion after bile-acid loading in normal and partially hepatectomized rats. , 1995, The Biochemical journal.

[19]  D. Beier,et al.  Interleukin-6 inhibits hepatocyte taurocholate uptake and sodium-potassium-adenosinetriphosphatase activity. , 1994, The American journal of physiology.

[20]  R. Jones,et al.  Bile Secretion and Liver Regeneration in Partially Hepatectomized Rats , 1993, Annals of surgery.

[21]  N. Hamajima,et al.  Logistic regression and discriminant analyses of hepatic failure after liver resection for carcinoma of the biliary tract , 1993, World Journal of Surgery.

[22]  A. Hofmann.  Bile acid secretion, bile flow and biliary lipid secretion in humans. , 1990, Hepatology.

[23]  M. Makuuchi,et al.  Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. , 1990, Surgery.

[24]  K. Tranberg,et al.  Major Liver Resection for Hilar Cholangiocarcinoma , 1988, Annals of surgery.

[25]  L. Zieve,et al.  Course of hepatic regeneration after 80% to 90% resection of normal rat liver. Comparison with two-lobe and one-lobe hepatectomy. , 1985, The Journal of laboratory and clinical medicine.

[26]  Y. Saitoh,et al.  Bile acid metabolism in partially hepatectomized rats , 1985, Steroids.

[27]  W. Bechstein,et al.  In liver transplantation, T tube bile represents total bile flow: physiological and scintigraphic studies on biliary secretion of organic anions. , 1999, Liver transplantation and surgery : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[28]  M. Nagino,et al.  Active form of human hepatocyte growth factor is excreted into bile after hepatobiliary resection. , 1999, Journal of hepatology.

[29]  M. Nagino,et al.  Changes in hepatic lobar function after right portal vein embolization. An appraisal by biliary indocyanine green excretion. , 1996, Annals of surgery.

[30]  S. Kawasaki,et al.  Outcome of Major Hepatectomy with Pancreatoduodenectomy for Advanced Biliary Malignancies , 1996, World Journal of Surgery.

[31]  H. Fujii,et al.  Multiple organ failure associated with postoperative non-obstructive jaundice. , 1987 .

[32]  M. Nakahara,et al.  Correlation between cellular ATP level and bile excretion in the rat liver. , 1985, Transplantation.