Relationship between Hepatic and Renal Function in Malignant Obstructive Jaundice Patients Undergoing Percutaneous Self-expanding Metal Biliary Stent

  Objective  To explore the hepatic function factors related to renal function in patients with malignant obstructive jaundice undergoing percutaneous self-expanding metal biliary stents (SEMS) implantation to restore internal drainage.

  Methods  We reviewed the clinical data of 91 consecutive patients with malignant obstructive jaundice who received SEMS implantation to restore internal biliary drainage in Peking Union Medical College Hospital between January 2005 and May 2014. They were all preoperatively confirmed cases of inoperable malignant biliary obstruction, including 38 men and 53 women, with the mean age of (67.25±13.41) years and mean hospital stay of (12.02±9.96) days. Renal function was assessed by creatinine clearance rate, glomerular filtration rate (GFR) estimated using the Modification of Diet in Renal Disease (MDRD) formula, and blood urea nitrogen and electrolytes (Na, K, Ca, Cl) levels. Hepatic function was assessed by measuring levels of total bilirubin (TB), direct bilirubin (DB), alanine aminotransferase (ALT), aspartate aminotransferase(AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total protein (TP), and albumin (Alb). The data were all obtained with fully automatic biochemical analyzer before SEMS implantation, and before discharge. Quantile regression analysis was used to analyze hepatic functional factors related with GFR change.

  Results  The hepatic function indicators significantly decreased after SEMS implantation in these patients(all P < 0.05), among which TB, DB, ALT, AST, GGT, ALP, TP, and Alb decreased by 23%, 24%, 36%, 40%, 59%, 32%, 25%, and 10%, respectively. While the renal function indicators showed no significant change after SEMS implantation. Quantile regression analysis showed that only serum DB/TB ratio was significantly correlated with GFR (P=0.0034).

  Conclusions  DB/TB ratio in malignant obstructive jaundice may be associated with renal dysfunction. Early "one-step" percutaneous SEMS implantation is therefore recommended for patients with high DB/TB ratio to restore internal drainage.