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Hepatobiliary transporter expression and post-operative jaundice in patients undergoing partial hepatectomy

Authors

  • Gerwin A. Bernhardt,

    Corresponding author
    1. Department of Surgery, District Hospital of Voitsberg, Voitsberg, Austria
    • Division of General Surgery, Department of Surgery, Medical University of Graz,, Graz, Austria
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  • Gernot Zollner,

    1. Laboratory of Experimental and Molecular Hepatology, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz,, Graz, Austria
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  • Herwig Cerwenka,

    1. Division of General Surgery, Department of Surgery, Medical University of Graz,, Graz, Austria
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  • Peter Kornprat,

    1. Division of General Surgery, Department of Surgery, Medical University of Graz,, Graz, Austria
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  • Peter Fickert,

    1. Laboratory of Experimental and Molecular Hepatology, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz,, Graz, Austria
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  • Heinz Bacher,

    1. Division of General Surgery, Department of Surgery, Medical University of Graz,, Graz, Austria
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  • Georg Werkgartner,

    1. Division of General Surgery, Department of Surgery, Medical University of Graz,, Graz, Austria
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  • Gabriele Müller,

    1. Division of General Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
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  • Kurt Zatloukal,

    1. Institute of Pathology, Medical University of Graz, Graz, Austria
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  • Hans-Jörg Mischinger,

    1. Division of General Surgery, Department of Surgery, Medical University of Graz,, Graz, Austria
    2. Department of Surgery, District Hospital of Voitsberg, Voitsberg, Austria
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  • Michael Trauner

    1. Laboratory of Experimental and Molecular Hepatology, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz,, Graz, Austria
    2. Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna,, Vienna, Austria
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Correspondence

Dr Gerwin Alexander Bernhardt

Division of General Surgery, Department of Surgery, Medical University Graz

Auenbruggerplatz 29,

8036 Graz, Austria

Tel: +43 3142 201 2916

Fax: +43 316 385 14666

e-mail: gerwin.bernhardt@lkh-voitsberg.at

Abstract

Background and aims

Post-operative hyperbilirubinaemia in patients undergoing liver resections is associated with high morbidity and mortality. Apart from different known factors responsible for the development of post-operative jaundice, little is known about the role of hepatobiliary transport systems in the pathogenesis of post-operative jaundice in humans after liver resection.

Methods

Two liver tissue samples were taken from 14 patients undergoing liver resection before and after Pringle manoeuvre. Patients were retrospectively divided into two groups according to post-operative bilirubin serum levels. The two groups were analysed comparing the results of hepatobiliary transporter [Na-taurocholate cotransporter (NTCP); multidrug resistance gene/phospholipid export pump(MDR3); bile salt export pump (BSEP); canalicular bile salt export pump (MRP2)], heat shock protein 70 (HSP70) expression as well as the results of routinely taken post-operative liver chemistry tests.

Results

Patients with low post-operative bilirubin had lower levels of NTCP, MDR3 and BSEP mRNA compared to those with high bilirubin after Pringle manoeuvre. HSP70 levels were significantly higher after ischaemia–reperfusion (IR) injury in both groups resulting in 4.5-fold median increase. Baseline median mRNA expression of all four transporters prior to Pringle manoeuvre tended to be lower in the low bilirubin group whereas expression of HSP70 was higher in the low bilirubin group compared to the high bilirubin group.

Discussion

Higher mRNA levels of HSP70 in the low bilirubin group could indicate a possible protective effect of high HSP70 levels against IR injury. Although the exact role of hepatobiliary transport systems in the development of post-operative hyper bilirubinemia is not yet completely understood, this study provides new insights into the molecular aspects of post-operative jaundice after liver surgery.

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