Analysis of the components of hypertransaminasemia after liver resection

Background: The increase in plasma aspartate (AST) and alanine (ALT) aminotransferase after liver resection is multifactorial, and a major problem is the difficult quantification of the impact of each factor involved. Methods: Regression analysis of a large series of measurements for 92 hepatectomy patients was carried out to assess in detail the postoperative evolution of AST and ALT, together with related components. Results: The best correlate of increased AST and ALT on postoperative day 1 was the duration of surgery (T-surg) (r(2) = 0.311 and 0.29), with a lower correlation for intraoperative liver ischernia (T-isch) (r(2) = 0.22 and 0.17, respectively; p < 0.001 for all). Subsequently AST decreased more quickly than ALT and both followed an inverse exponential pattern. T-surg, T-isch, time after surgery and plasma bilirubin explained 77% and 51% of the variability of AST and ALT, respectively, for all postoperative measurements (p < 0.001 for both). The best correlate of T-isch was a delayed increase in bilirubin, detected on postoperative day 7, attenuated by the use of intermittent liver ischernia. Conclusions: These data show that T-isch may not be the main determinant of increased transaminases after hepatectomy, and provide a quantitative analysis of the main impact of the trauma of liver resection, liver ischernia, and other factors on the postoperative evolution of transaminases.