Analysis of bilirubin and bile acid fractions in serum and bile juice after living related liver transplantation

Though various complications occur after liver transplantation, the differential diagnosis of those complications is very difficult. Especially it is so difficult to diagnose acute rejection without liver biopsy. Therefore, we attempted to analyze bilirubin and bile acid fractions in serum and bile juice after liver transplantation for diagnosis of complication. Eleven children were included in this study, who underwent living related liver transplantation at the Second Department of Tohoku University School of Medicine. As complications, we experienced acute rejection in 6 cases, severe infection in 3, portal thrombosis in 2, arterial thrombosis in 1 and cholangitis in 1. Each fraction was measured by using high performance liquid chromatography (HPLC) and several indexes were calculated. In the bilirubin fraction of the serum, specific changes were not recognized in each complication. But bilirubin fraction in serum tended to change peculiarly depend on complications. In acute rejection, the rate of diglucuronide bilirubin (BDG) to the total amount of conjugated bilirubin (Bc) in bile juice was lower without decrease of Bc. In other severe complication, i.e., hepatic artery thrombosis and bile stasis due to cholangitis, both BDG/Bc ratio and Bc took lower level. Analysis of bile acid fraction both in serum and bile did not demonstrate peculiar changes. In conclusion, it was suggested that serum and biliary bilirubin fraction after liver transplantation could be reliable marker at the acute rejection.