Demystifying Post-hepatectomy Enzyme Kinetics for the Surgical Learner: An Analysis of 989 Major Hepatectomies

Abstract

Introduction: Few resources exist for surgical learners in interpreting trends in biochemical markers following major hepatic resections. Methods: Adult patients who underwent major hepatectomy between 2010-2020 were included from twelve international centers. Patients were classified as healthy donor, benign disease, non-alcoholic fatty liver disease, prior chemotherapy, or cirrhosis. Median values of total bilirubin and INR were plotted against time and compared across groups using the Kruskal-Wallis test. Results: Across groups (n=989), median total bilirubin and INR were observed to peak on postoperative day (POD) 1. While the healthy donor group (n=156) had the highest median total bilirubin on POD1 (2.4, IQR: 1.7-3.3), they had the fastest rate of recovery such that by POD5, values were lower than those of the NAFLD (n=26), chemotherapy (n=92), and cirrhosis (n=668) groups. Donor patients also had the highest POD1 INR (median 1.5, IQR: 1.4-1.7), while patients with NAFLD had the highest POD5 INR levels (1.2, IQR 1.1, 1.4). The lowest POD1 total bilirubin and INR levels were observed in the cirrhosis group (1.5, 1.3 respectively). Statistically significant differences in total bilirubin and INR were observed across groups at all time points (p<0.05). Conclusions: We observed the healthy donor patients to have the highest postoperative enzyme peaks, but most rapid rate of return to normal. This illustration of the postoperative kinetics of biochemical liver function tests may serve as a useful reference for clinical learners monitoring patients in the first week following major hepatectomy.