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Dexamethasone for postoperative hyperbilirubinemia in patients after liver resection: An open-label, randomized controlled trial

  • Cheng Huang
    Affiliations
    Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory for Carcinogenesis and Cancer Invasion, Chinese Ministry of Education; Shanghai, China
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  • Xiao-Dong Zhu
    Affiliations
    Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory for Carcinogenesis and Cancer Invasion, Chinese Ministry of Education; Shanghai, China
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  • Guo-Ming Shi
    Affiliations
    Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory for Carcinogenesis and Cancer Invasion, Chinese Ministry of Education; Shanghai, China
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  • Ying-Hao Shen
    Affiliations
    Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory for Carcinogenesis and Cancer Invasion, Chinese Ministry of Education; Shanghai, China
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  • Guang-Yu Ding
    Affiliations
    Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory for Carcinogenesis and Cancer Invasion, Chinese Ministry of Education; Shanghai, China
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  • Jia-Bin Cai
    Affiliations
    Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory for Carcinogenesis and Cancer Invasion, Chinese Ministry of Education; Shanghai, China
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  • Jian Zhou
    Affiliations
    Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory for Carcinogenesis and Cancer Invasion, Chinese Ministry of Education; Shanghai, China
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  • Jia Fan
    Affiliations
    Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory for Carcinogenesis and Cancer Invasion, Chinese Ministry of Education; Shanghai, China
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  • Hui-Chuan Sun
    Correspondence
    Corresponding author: Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, China. Cheng Huang and Xiao-Dong Zhu contributed equally to this work.
    Affiliations
    Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory for Carcinogenesis and Cancer Invasion, Chinese Ministry of Education; Shanghai, China
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Published:October 19, 2018DOI:https://doi.org/10.1016/j.surg.2018.09.002

      Abstract

      Background

      Although prophylactic glucocorticoids have been used before liver resection to minimize liver dysfunction, it is unknown whether treatment with glucocorticoids will accelerates recovery from hyperbilirubinemia after liver resection.

      Methods

      In this open-label, randomized, controlled trial, patients with hyperbilirubinemia (>2.5 × and ≤5 × the upper limit of normal) within 7 days after hepatic resection were assigned randomly to the dexamethasone or control groups. For the dexamethasone group, 10 mg, 10 mg, and 5 mg dexamethasone were administered intravenously on days 0, 1, and 2, respectively, after randomization. For the control group, patients received standard treatment only. The primary outcome was time to recovery from hyperbilirubinemia defined as the period from the day of randomization to the day when serum bilirubin decreased to ≤1.5 times that of the upper limit of normal. Secondary outcomes were the prevalence of postoperative complications, postoperative hospital stay, and hospital expense.

      Results

      Between March 2016 and December 2017, 76 participants were enrolled (38 in each group). Median time to recovery from hyperbilirubinemia was less in the dexamethasone group than in the control group (2 vs 4 days, P < .001). Serum bilirubin levels were less in the dexamethasone group on days 1–3 after randomization (P < .05). The prevalence of infection, posthepatectomy liver failure, postoperative hospital stay, and hospital expense were not different between the groups.

      Conclusion

      Dexamethasone accelerated recovery from hyperbilirubinemia and decreased serum bilirubin levels without causing more side effects in patients after hepatectomy.
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