Effects of preoperative 5-aminolevulinic acid administration on postoperative liver enzymes after brain tumor surgery in patients with elevated preoperative liver enzymes. (February 2020)

• Record Type: Journal Article
• Authors: Oh, Hyongmin; Park, Jung-Bin; Yoon, Hyun-Kyu; Lee, Hyung-Chul; Park, Chul-Kee; Park, Hee-Pyoung
• Is Part Of: Journal of clinical neuroscience. Volume 72(2020)
• Page Start: 304
• Page End: 309
• Publication Date: 2020-02
• Subjects: 5-Aminolevulinic acid -- Liver enzymes -- Brain neoplasms -- Neurosurgery; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2019.08.118
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: 5-Aminolevulinic acid (5-ALA) causes postoperative increase in liver enzymes (PILE). 5-ALA was given to patients with elevated preoperative liver enzymes (EPLE). The incidence of PILE after 5-ALA administration was 45.5% in patients with EPLE. Most PILEs were temporary and the incidence of severe PILE was low. Administering 5-ALA is relatively safe even in patients with EPLE. Abstract: The effect of 5-aminolevulinic acid (5-ALA) on a postoperative increase in liver enzymes (PILE) has not been clearly investigated in patients with elevated preoperative liver enzymes. The aim of this study was to evaluate the safety of 5-ALA in brain tumor patients with elevated preoperative liver enzymes by investigating the incidence, severity, and duration of PILE. This retrospective study was conducted in patients with a brain tumor who received 5-ALA preoperatively and had a preoperative increase in liver enzymes. Laboratory data on serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and total bilirubin (TB) levels were collected preoperatively and through postoperative day (POD) 30. The incidence and severity of PILE was evaluated based on the Common Terminology Criteria for Adverse Events. Among 134 patients, 61 (45.5%) developed 97 episodes (grade 1/2/3: 80/10/7) of PILE. Postoperative increases in ALT, AST, ALP, and TB were observed in 41 (30.6%), 33 (24.6%), 6 (4.5%), and 17 (12.7%) patients respectively. Five (3.7%) and two (1.5%) patients showed grade 3 increases in ALT and AST respectively. The maximum liver enzyme levels shown in 97 episodes resolved to preoperative baseline or normal (n = 70), grade 1 (n = 24), and grade 2 (n = 3) levels within POD 30. The incidence of PILE after 5-ALA-guided brain tumor surgery in patients with increased preoperative liver enzymes was 45.5%. However, most PILEs were temporary and the incidence of severe PILE was low, suggesting that administering 5-ALA is relatively safe even in patients with elevated preoperative liver enzymes.