Predictive factors for intrahepatic cholestasis after orthotopic liver transplantation have not yet been established.
Dr Andrew Burroughs and colleagues identified the incidence and risk factors of severe intrahepatic cholestasis after orthotopic liver transplantation.
The investigative team assessed 428 consecutive patients undergoing their first orthotopic liver transplantation.
|Intrahepatic cholestasis developed in 25%|
Prolonged and severe intrahepatic cholestasis was diagnosed if a serum bilirubin concentration was greater than 100 mol/L.
The diagnosis was also made with a 3-fold increase of alkaline phosphatase occurred within the first month after orthotopic liver transplantation.
For the diagnosis to be confirmed, the serum bilirubin and alkaline phosphatase levels were sustained for at least 1 week in the absence of biliary complications.
Multivariable logistic regression identified factors independently associated with prolonged and severe intrahepatic cholestasis.
Prolonged and severe intrahepatic cholestasis developed in 25% of patients.
Independent risk factors by multivariable analysis were intraoperative transfusion of cryoprecipitate and platelets.
The investigators found that nonidentical blood group status, and suboptimal organ appearance were risk factors.
The team observed that inpatient status before transplantation, and bacteremia in the first month after transplantation were also risk factors.
In contrast, the team found that acute liver failure, and older age were associated with a reduced likelihood of developing severe intrahepatic cholestasis.
Higher levels of serum sodium and serum potassium were associated with a reduced risk of developing severe intrahepatic cholestasis in the first month.
There were 47 deaths in the severe intrahepatic cholestasis group as opposed to 65 deaths in the non-severe intrahepatic cholestasis group after transplantation.
A poor preoperative clinical status in conjunction with a suboptimal graft was associated with intrahepatic cholestasis after transplantation.
Dr Burroughs' team comments, “Avoidance of suboptimal livers and ABO nonidentical grafts for young patients with poor synthetic function, and for pretransplant inpatients, may lessen this complication and reduce the associated early mortality.”