Published online May 27, 2026. doi: 10.4254/wjh.v18.i5.119408
Revised: February 13, 2026
Accepted: March 25, 2026
Published online: May 27, 2026
Processing time: 119 Days and 19 Hours
Liver transplantation (LT) remains the definitive treatment for patients with acute and chronic end-stage liver disease, significantly improving survival and quality of life. Conventional liver function tests post LT, while routinely used, often lack sensitivity and may not detect graft injury promptly. Serum bile acids (SBAs), known for their role in hepatic function and enterohepatic circulation, have em
To assess correlations between SBA concentrations and clinical outcomes, including graft function and rejection episodes.
Relevant studies analyzing SBA levels after LT were systematically reviewed. Data synthesis focused on the association between bile acid levels and transplant outcomes.
Elevated SBA levels were significantly associated with early graft dysfunction and acute rejection. Pooled analysis indicated that patients with SBA levels exceeding study-specific thresholds had a 2.5-fold increased risk of acute rejection (95%CI: 1.8-3.4, P < 0.001). Diagnostic accuracy analysis showed that SBA levels had a sensitivity of 82% and specificity of 76% for predicting graft dysfunction within the first month after transplantation. Subgroup analyses highlighted conjugated bile acids as particularly predictive, with an odds ratio of 3.1 (95%CI: 2.0-4.8, P < 0.0001) for adverse outcomes.
SBA levels demonstrate strong potential as a non-invasive early biomarker for post-liver transplant prognosis, facilitating timely clinical interventions. However, heterogeneity in assay techniques and cutoff values across studies underscores the need for standardized measurement protocols. Incorporating SBA monitoring into routine post-transplant surveillance may enhance prognostic precision and improve patient management strategies.
Core Tip: Serum bile acid (SBA) levels serve as a sensitive, non-invasive biomarker for early detection and prognosis of graft dysfunction, acute rejection, patient survival, and biliary complications following liver transplantation. Elevated SBA levels correlate strongly with adverse outcomes, often preceding changes in conventional liver function tests. Despite promising diagnostic accuracy, heterogeneity in assay methods and cutoff values limits routine clinical use. Standardized protocols and large multicenter prospective studies are needed to validate SBA monitoring as a complementary tool to established biochemical tests, enhancing post-transplant surveillance and timely intervention strategies.