Bilirubin fractions Be and DELTA, not routinely available prior to the EKTACHEM Chemistry Analyzer and its slide methodology, were studied in an outpatient population of liver transplant recipients. A preliminary evaluation by the authors has shown that direct bilirubin (DBILI) levels in the normal range consist almost exclusively of DELTA (protein-bound conjugated bilirubin), while at elevated DBILI levels, an increasing amount of Be (non-protein-bound conjugated bilirubin) is measured as well. The present study evaluated the clinical significance of Be in the serum of 80 liver transplant recipients as a means of identifying episodes of rejection. Each patient was classified into rejection or nonrejection categories based on clinical status, liver biopsy results, and/or response to therapy. Eighteen patients were classified as experiencing an episode of rejection during the period of this study. Fourteen of these (77.8%) had Be levels that ranged from 0.1 to 6.8 mg/ dl. Sixty two patients were classified in the nonrejection category. Fourteen (22.6%) of these patients had Be levels that ranged from 0.1 to 0.6 mg/dl. In our outpatient liver transplant recipients with Be ≥0.1 mg/dl, the relative risk of rejection (% of rejection patients with Bc/% of nonrejection patients with Be) was 3.44. This value indicates that Be determination may be a helpful adjunct in the assessment of rejection.
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