Changes in bilirubin pigments secreted in bile after liver transplantation

Authors

  • Dr. Carl A. Goresky,

    Corresponding author
    1. Division of Gastroenterology and the McGill University Medical Clinic in the Montreal General Hospital, Montreal, Quebec, H3G 1A4 Canada
    • Montreal General Hospital, Room 1068, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada
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  • Ellen R. Gordon,

    1. Division of Gastroenterology and the McGill University Medical Clinic in the Montreal General Hospital, Montreal, Quebec, H3G 1A4 Canada
    2. the Liver Study Unit, Yale University School of Medicine, New Haven, Connecticut 06510
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  • Juan-Ramon Sanabria,

    1. Department of Surgery and Lunenfeld Research Institute, Mt. Sinai Hospital, Toronto, Ontario, M5G 1X5 Canada
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  • Steven M. Strasberg,

    1. Department of Surgery and Lunenfeld Research Institute, Mt. Sinai Hospital, Toronto, Ontario, M5G 1X5 Canada
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  • M. Wayne Flye

    1. the Liver Study Unit, Yale University School of Medicine, New Haven, Connecticut 06510
    Current affiliation:
    1. Department of Surgery and Pediatrics, Washington University School of Medicine, St. Louis, MO 63110
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Abstract

The species of bile pigments secreted in T-tube fistula bile after liver transplantation were ascertained by high-performance liquid chromatography in 15 patients for 10 days after liver transplant. Nine glycosidic conjugates and unconjugated bilirubin were resolved by the analytical procedure. The principal pigments in bile and their proportions in normal patients were the following: bilirubin diglucuronide = 83.0% ± bilirubin monoglucuronide = 9.7% ± 1.4% (S.D.); bilirubin monoglucuronide monoglucoside = 4.0% 2.8% (S.D.); and bilirubin monoglucuronide monoxyloside = 1.5% ± 1.8% (S.D.). All of the other possible glucuronide, glucose and xylose monoconjugates and diconjugates and unconjugated bilirubin were also found, but each was normally less than 1% of the total. In 13 of the 15 transplant patients, a significant depression in proportions of bilirubin diglucuronide and elevation in proportions of bilirubin monoglucuronide were found after the transplant, with an accompanying but generally small increase in the proportions of the minor conjugates. In two patients with rejection of the transplant, the changes were of larger magnitude, with improvement occurring only with recovery from the rejection. In one of these patients, kidney failure was present, and in addition to the diglucuronide and monoglucuronide conjugates diglucoside and monoglucoside monoxyloside conjugates were found in plasma. The underlying metabolic abnormalities are not clear but likely reflect underlying abnormal intracellular cofactor levels for conjugation. Glycogen depletion with reduction of UDP-glucuronate levels or reduced UDP-glucuronate formation from UDP-glucose, secondary to elevation of UDP-xylose, could potentially account for the changes in pigment excretion. (HEPATOLOGY 1992;15:849–857).

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