The Clinical Meanings Of Serum Bile Acid Monitoring In Patients Undergoing Liver Transplantation

Objective: Liver transplantation as the last way to rescue a patient of the end state liver disease has been developed broadly in our country. But there is no efficient or reliable chemo-physiology index yet for the early diagnosis of the disease, such as the acute rejection reaction and the primary graft failure. Maintenance of normal serum bile acid concentrations depends on hepatic blood flow, hepatic uptake, secretion of bile acids, and intestinal motility. A disease that affects any of these functions should theoretically affect serum bile acid levels. This has proved to be true in practice. Serum bile acids are sensitive but nonspecific indicators of hepatic dysfunction. They allow some quantification of functional hepatic reserve. To all liver disease serum bile acids are more sensitive than the total bilirubin,and are influenced by the renal function in some extent. This experiment does the retrospective analysis by observing and comparing with other indexes the total bile acid (TBA) in serum of patients before and after the liver transplantation and probes into how they change in the disease after transplantation which can instruct the clinical treatment.Method: Collect the serum sample before liver transplantation and in the first week of a patient after the liver transplantation. Get data after treating the samples. Compare this data with other chemo-physiology indexes, such as the glutamicoxalacetic transaminase (AST) and the total bilirubin (TBIL), do clinical retrospective analysis and get a conclusion. Results:1.Before liver transplantation increasing in grade with Child, the TBA increases as well with grade C>grade B>grade A, and there is distinct difference among the grades. Also the TBA increases with increasing in score with MELD. After liver transplantation the TBA decreases with the recovery of the liver function and there is no distinct difference among the grades.2.Before transplantation the TBA level in patients with acute renal failure after liver transplantation is higher than in patients without acute renal failure. After transplantation the TBA level and the total bilirubin increases in patients with acute renal failure after liver transplantation. The increase of the TBA level is earlier than the increase of the total bilirubin.3.In the rejection reaction, the TBA may increase obviously. Along with the cure of the rejection reaction and the recovery of liver function, the TBA becomes normal gradually again, and this change occurs earlier than the AST and the TBIL for one to three days,. So,TBA can be seen as a early index for clinically evaluating the rejection after the transplantation.4. Infections didn't lead to significance TBA increase.Conclusion: The total bile acid and the ratio of CA/CDCA can be early sensitive index for clinically evaluating the recovery condition of the liver function after transplantation1.Different level ill-function of liver exists before the transplantation of a patient. And the TBA in serum increases which makes a direct ratio to the liver injury. After transplantation the TBA in serum is associated with the recovery of liver function.2.Before transplantation the TBA level in patients with acute renal failure after liver transplantation is higher than in patients without acute renal failure. After transplantation the TBA level and the total bilirubin increases in patients with acute renal failure after liver transplantation. The increase of the TBA level is earlier than the increase of the total bilirubin. So the TBA level may be a influent factor to the etiology of acute renal failure following liver transplantation and can be a early indictator to acute renal failure. 3.As the recovery of liver function, the total bile acid in serum reduces gradually after the transplantation, whereas the change is severe when rejection reaction occurs. TBA increases rapidly. And along with the cure of rejection reaction and the recovery of liver function, TBA becomes normal again. So,TBA can be seen as the index for clinically evaluating the rejection after the transplantation.4. Infections after liver transplantation have no significant influence on the serum TBA level.