Plasma bilirubin correlations in non-obstructive cholestasis after partial hepatectomy

Background: The aim of this study was to provide an improved outline of the patterns and correlates of changes in plasma bilirubin after partial hepatectomy. Methods: A large series of blood measurements and complementary variables were prospectively collected from 85 patients undergoing liver resection, and bilirubin correlations were assessed by regression analysis. Results: Early postoperatively, the best simultaneous correlates of increasing bilirubin were the preoperative value, the duration of surgery, and the number of blood transfusions (r(2)=0.74, p<0.001). Subsequently, increasing bilirubin became related to the number of resected liver segments, the duration of intraoperative liver ischemia, the use of continuous vs. intermittent ischemia, and the presence of sepsis (r(2)=0.82, p<0.001); these were also the best simultaneous correlates of peak bilirubin. This pattern was characterized by prominently conjugated hyperbilirubinemia, hypocholesterolemia, and moderately increased alkaline phosphatase, and occurred in the absence of obstructive cholestasis. Conclusions: Major hepatectomy, parenchymal ischemia, and sepsis have similar and synergistic impacts as determinants of prominently conjugated hyperbilirubinemia after liver resection. This is likely related to impaired hepatocellular bilirubin transport and occurs in the absence of obstructive components.