101. Post-hepatectomy hyperbilirubinemia: The point of no return
- Author
-
David A. Kooby, Kenneth Cardona, Joanna W. Etra, Malcolm H. Squires, Shishir K. Maithel, Joshua H. Winer, Jessica Liu, Lauren M. Postlewait, Maria C. Russell, Charles A. Staley, and Juan M. Sarmiento
- Subjects
Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Point of no return ,Future studies ,Georgia ,Bilirubin ,medicine.medical_treatment ,03 medical and health sciences ,chemistry.chemical_compound ,Plasma ,Young Adult ,0302 clinical medicine ,Postoperative Complications ,Medicine ,Hepatectomy ,Humans ,Aged ,Hyperbilirubinemia ,Retrospective Studies ,Aged, 80 and over ,Chemotherapy ,business.industry ,Age Factors ,General Medicine ,Middle Aged ,Liver Insufficiency ,Neoadjuvant Therapy ,Surgery ,chemistry ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Multivariate Analysis ,030211 gastroenterology & hepatology ,Female ,business ,Major hepatectomy - Abstract
Post-hepatectomy hyperbilirubinemia is associated with liver insufficiency and failure. The highest survivable peak total bilirubin (ptbili) is not defined. This study aimed to identify the postop ptbili beyond which survival is improbable or impossible.An institutional database of major hepatectomies (≥3 segments, no biliary resections), 2000-2012 was reviewed. Data were analyzed to find ptbili in the first 45 postop days. Factors associated with 90-day mortality (90 DM) and those predictive of ptbili were determined.603 pts were analyzed with 90DM of 4.5%. 90 DM for a ptbili ≥ 18 (n = 15) was 86.6%, but only 2.5% for a ptbili 18. All 6 pts with a ptbili ≥ 30 died. On multivariate analysis, postop ptbili ≥ 18 (HR34.95, CI 3.8-324; p = 0.002) and cirrhosis (HR6.4, CI 1.2-33.2; p = 0.027) were associated with 90DM. Factors associated with a ptbili ≥ 18 were age65 (HR14.24, CI 2.9-70.5; p = 0.001), preop chemotherapy (HR4.77, CI 1.3-18.2; p = 0.02) and postop FFP (HR12.5, CI 2.6-56.2; p = 0.001).Postop ptbili ≥ 18 after major hepatectomy has an 86.6% risk of 90DM; there are no survivors for tbili ≥ 30. These values may guide postop counseling for prognosis. Future studies may evaluate tbili ≥ 18 as an indication for hepatic replacement therapy.
- Published
- 2016