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Association between Serum Bilirubin and Acute Intraoperative Hyperglycemia Induced by Prolonged Intermittent Hepatic Inflow Occlusion in Living Liver Donors. PLoS One 2016;11(7):e0156957

Date

07/02/2016

Pubmed ID

27367602

Pubmed Central ID

PMC4930162

DOI

10.1371/journal.pone.0156957

Scopus ID

2-s2.0-84978081438 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

BACKGROUND: Intermittent hepatic inflow occlusion (IHIO) is associated with acute hyperglycemia during living donor hepatectomy when the ischemia is prolonged. Bilirubin is a potent antioxidant to play an important role for maintaining insulin sensitivity and preventing hyperglycemia. Thus, we aimed to test whether serum bilirubin level is associated with prolonged IHIO-induced intraoperative hyperglycemia.

METHODS: Seventy-five living liver donors who underwent a prolonged IHIO with a >30 minute cumulative ischemia were included. The association between preoperative serum bilirubin concentrations and the risk of intraoperative hyperglycemia (blood glucose concentration >180 mg/dl) was analyzed using binary logistic regression with adjusting for potential confounders including age and steatosis.

RESULTS: The number of donors who underwent 3, 4, 5, and 6 rounds of IHIO was 41, 22, 7, and 5, respectively. Twenty-nine (35%) donors developed intraoperative hyperglycemia. Total bilirubin concentration was inversely associated with hyperglycemia risk (odds ratio [OR] 0.033, 95% confidence interval [CI] 0.004-0.313, P = 0.003). There was an interaction between age and total bilirubin concentration: the effect of lower serum total bilirubin (≤0.7 mg/dl) on the development of hyperglycemia was greater in older donors (>40 years) than in younger donors (P = 0.0.028 versus P = 0.212). Both conjugated bilirubin (OR 0.001 95% CI 0.001-0.684) and unconjugated bilirubin (OR 0.011 95% CI 0.001-0.246) showed an independent association with hyperglycemia risk.

CONCLUSIONS: Lower preoperative serum bilirubin was associated with greater risk of prolonged IHIO-induced hyperglycemia during living donor hepatectomy particularly in older donors. Thus, more meticulous glycemic management is recommended when prolonged IHIO is necessary for surgical purposes in old living donors with lower serum bilirubin levels.

Author List

Han S, Jin SM, Ko JS, Kim YR, Gwak MS, Son HJ, Joh JW, Kim GS

Author

Justin Ko MD, PhD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Acute Disease
Adult
Bilirubin
Female
Hepatectomy
Humans
Hyperglycemia
Intraoperative Period
Liver Transplantation
Living Donors
Male
Middle Aged
Prognosis
Retrospective Studies
Time Factors