Association between Serum Bilirubin and Acute Intraoperative Hyperglycemia Induced by Prolonged Intermittent Hepatic Inflow Occlusion in Living Liver Donors.

Sangbin Han,Mi Sook Gwak,Sang-Man Jin,Jae-Won Joh,Gaab Soo Kim,Justin Sangwook Ko,Hee Jeong Son,Young Ri Kim,Stanislaw Stepkowski

doi:10.1371/journal.pone.0156957

Abstract

BackgroundIntermittent 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.MethodsSeventy-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.ResultsThe 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.ConclusionsLower 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.

Highlights

The severe shortage of available liver transplant grafts has led to the acceptance of living donors
Total bilirubin concentration was inversely associated with hyperglycemia risk
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)

Summary

Introduction

The severe shortage of available liver transplant grafts has led to the acceptance of living donors. Living donor hepatectomy has been associated with considerable complications. Most of the complications are reversible and short-term, concerns for the safety of healthy donors should be more emphasized to minimize harm to them from the ethical standpoint. The mortality of living liver donors has not been zero. In a report published in 2006, there were 19 known deaths (0.15% mortality) and 5 donors of them died due to infectious complications [3]. Intermittent hepatic inflow occlusion (IHIO) is associated with acute hyperglycemia during living donor hepatectomy when the ischemia is prolonged. We aimed to test whether serum bilirubin level is associated with prolonged IHIOinduced intraoperative hyperglycemia

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Conclusion