Transaminasas en el primer día poshepatectomía y predicción de resultados en patología maligna
DOI:
https://doi.org/10.52787/agl.v55i4.547Palabras clave:
Hepatectomía, complicaciones postoperatorias, mortalidad, aspartato aminotransferasa, alanina aminotransferasaResumen
Introducción. Los avances en la cirugía hepática oncológica han mejorado la radicalidad de los procedimientos y ampliado los criterios de resecabilidad. Las transaminasas pueden ser indicadores de injuria hepatocelular postoperatoria.
Objetivos. Evaluar la relación entre las transaminasas del primer día postoperatorio y la morbimortalidad en las hepatectomías por patología maligna.
Materiales y métodos. Análisis retrospectivo de hepatectomías por patología maligna entre marzo de 2015 y febrero de 2023. Se evaluaron variables demográficas, intraoperatorias y postoperatorias. Se determinaron los valores de corte óptimos de transaminasas y su relación con las complicaciones y la mortalidad mediante curvas ROC y cálculos de sensibilidad y especificidad.
Resultados. Realizamos 273 hepatectomías en nuestra institución, 118 por patología maligna. Hallamos una relación estadísticamente significativa entre los valores elevados de las transaminasas en el primer día postoperatorio y el desarrollo de la morbimortalidad. Los puntos de corte para predecir mortalidad fueron 856 UI/L para la transaminasa glutámico-oxalacética y 1341 UI/L para la transaminasa glutámico-pirúvica (AUC: 0,714 y 0,579, respectivamente), y 530 UI/L y 257 UI/L para predecir la ocurrencia de complicaciones (AUC: 0,700 y 0,663). Los valores de transaminasas glutámico-oxalacética elevados se asociaron a insuficiencia hepática postoperatoria, con un punto de corte > 856 UI/L (AUC: 0,834).
Conclusión. Los valores elevados de transaminasas al primer día postoperatorio se asociaron con mayor ocurrencia de complicaciones, necesidad de hemoderivados y uso de drogas vasoactivas. Una transaminasa glutámico-oxalacética elevada indica un riesgo mayor de insuficiencia hepática postoperatoria y mortalidad a 90 días. Las transaminasas son marcadores pronósticos útiles en las hepatectomías por patología maligna.
Citas
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Derechos de autor 2025 Lourdes Mollard, Rodrigo A Gasque, Magalí Chahdi Beltrame, Marcelo E Lenz, Francisco J Mattera, Emilio G Quiñonez
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