Perioperative Changes in Serum Transaminase Levels: Impact on Postoperative Morbidity Following Liver Resection of Hepatocellular Carcinoma

Fumin Wang; Jingming Lu; Tian Yang; Yaoxing Ren; Francesca Ratti; Hugo P Marques; Silvia Silva; Olivier Soubrane; Vincent Lam; George A Poultsides; Irinel Popescu; Razvan Grigorie; Sorin Alexandrescu; Guillaume Martel; Aklile Workneh; Alfredo Guglielmi; Tom Hugh; Luca Aldrighetti; Itaru Endo; Yi Lv; Xu-Feng Zhang; Timothy M Pawlik

doi:10.1097/SLA.0000000000006235

Perioperative Changes in Serum Transaminase Levels: Impact on Postoperative Morbidity Following Liver Resection of Hepatocellular Carcinoma

Ann Surg. 2024 Feb 13. doi: 10.1097/SLA.0000000000006235. Online ahead of print.

Authors

Fumin Wang^{1

2}, Jingming Lu^{1

2}, Tian Yang³, Yaoxing Ren^{1

2}, Francesca Ratti⁴, Hugo P Marques⁵, Silvia Silva⁵, Olivier Soubrane⁶, Vincent Lam⁷, George A Poultsides⁸, Irinel Popescu⁹, Razvan Grigorie⁹, Sorin Alexandrescu⁹, Guillaume Martel¹⁰, Aklile Workneh¹⁰, Alfredo Guglielmi¹¹, Tom Hugh¹², Luca Aldrighetti⁴, Itaru Endo¹³, Yi Lv^{1

2}, Xu-Feng Zhang^{1

2}, Timothy M Pawlik¹⁴

Affiliations

¹ Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
² School of Future Technology, Xi'an Jiaotong University, Xi'an, PR China.
³ Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University, Shanghai, China.
⁴ Department of Surgery, Ospedale San Raffaele, Milano, Italy.
⁵ Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
⁶ Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy.
⁷ Department of Surgery, Westmead Hospital, Sydney, Australia.
⁸ Department of Surgery, Stanford University, Stanford, CA, USA.
⁹ Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
¹⁰ Department of Surgery, University of Ottawa, Ottawa, Canada.
¹¹ Department of Surgery, University of Verona, Verona, Italy.
¹² Department of Surgery, The University of Sydney, School of Medicine, Sydney, Australia.
¹³ Yokohama City University School of Medicine, Yokohama, Japan.
¹⁴ Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA.

PMID: 38348655
DOI: 10.1097/SLA.0000000000006235

Abstract

Objectives: To define how dynamic changes in pre- versus post-operative serum aspartate aminotransferase (AST) and alanine aminotransaminase (ALT) levels may impact postoperative morbidity after curative-intent resection of hepatocellular carcinoma (HCC).

Background: Hepatic ischemia/reperfusion can occur at the time of liver resection and may be associated with adverse outcomes following liver resection.

Methods: Patients who underwent curative resection for HCC between 2010-2020 were identified from an international multi-institutional database. Changes in AST and ALT (CAA) on postoperative day (POD) 3 versus preoperative values () were calculated using the formula: based on a fusion index via Euclidean norm, which was examined relative to the comprehensive complication index (CCI). The impact of CAA on CCI was assessed by the restricted cubic spline regression and Random Forest analyses.

Results: A total of 759 patients were included in the analytic cohort. Median CAA was 1.7 (range, 0.9 to 3.25); 431 (56.8%) patients had a CAA<2, 215 (28.3%) patients with CAA 2-5, and 113 (14.9%) patients had CAA ≥5. The incidence of post-operative complications was 65.0% (n=493) with a median CCI of 20.9 (IQR, 20.9-33.5). Spline regression analysis demonstrated a non-linear incremental association between CAA and CCI. The optimal cutoff value of CAA=5 was identified by the recursive partitioning technique. After adjusting for other competing risk factors, CAA≥5 remained strongly associated with risk of post-operative complications (Ref. CAA<5, OR 1.63, 95%CI 1.05-2.55, P=0.03). In fact, the use of CAA to predict post-operative complications was very good in both the derivative (AUC 0.88) and external (ACU 0.86) cohorts (n=1137).

Conclusions: CAA was an independent predictor of CCI after liver resection for HCC. Use of routine labs such as AST and ALT can help identify patients at highest risk of post-operative complications following HCC resection.