BACKGROUND: There is evidence that small-for-size liver grafts are more vulnerable to ischemia/reperfusion injury after liver transplantation. We hypothesized that ischemic injury is more pronounced in small liver remnants after major hepatectomies. METHODS: Fifteen patients underwent extended hepatectomy with remnant liver mass less than 30% of standard liver weight (study group). These patients were matched with patients who underwent minor liver resection, with liver remnants equal to or more than 70% of standard liver weight (control group). Ischemia/reperfusion injury was assessed by tissue caspase-3 activity postoperatively as well as peak aspartate aminotransferase (AST) values and a-glutathione S-transferase (α-GST) levels adjusted for remnant liver weight. In addition, caspase-3 activity and adjusted serum markers of hepatocyte injury were correlated with the degree of postoperative portal hypertension. RESULTS: Caspase-3 activity was higher in patients with small liver remnants (22.66±6.57 vs. 12.60±4.06 count per high-power field, p<0.001). Serum markers of hepatocyte injury, when adjusted per gram of liver remnant, were found to be higher in the study group than in the control group (AST: 1.26±0.25 vs. 0.54±0.11 IU g(-1), p<0.001; α-GST: 0.14±0.02 vs. 0.08±0.01 IU g(-1), p<0.001). Tissue caspase-3 expression in the small liver remnant group correlated with both AST and α-GST levels adjusted per gram of liver remnant (r2=0.51, p=0.005 and r2=0.71, p<0.001, respectively). Significant correlations between postoperative portal hypertension and the same markers as well as caspase-3 activity were also demonstrated. CONCLUSION: Liver remnants less than 30% of standard liver weight are much more susceptible to ischemia/reperfusion injury than controls twice the size. Adjustment of serum markers of hepatocyte injury to the liver remnant weight depicts injury more accurately.
BACKGROUND: There is evidence that small-for-size liver grafts are more vulnerable to ischemia/reperfusion injury after liver transplantation. We hypothesized that ischemic injury is more pronounced in small liver remnants after major hepatectomies. METHODS: Fifteen patients underwent extended hepatectomy with remnant liver mass less than 30% of standard liver weight (study group). These patients were matched with patients who underwent minor liver resection, with liver remnants equal to or more than 70% of standard liver weight (control group). Ischemia/reperfusion injury was assessed by tissue caspase-3 activity postoperatively as well as peak aspartate aminotransferase (AST) values and a-glutathione S-transferase (α-GST) levels adjusted for remnant liver weight. In addition, caspase-3 activity and adjusted serum markers of hepatocyte injury were correlated with the degree of postoperative portal hypertension. RESULTS:Caspase-3 activity was higher in patients with small liver remnants (22.66±6.57 vs. 12.60±4.06 count per high-power field, p<0.001). Serum markers of hepatocyte injury, when adjusted per gram of liver remnant, were found to be higher in the study group than in the control group (AST: 1.26±0.25 vs. 0.54±0.11 IU g(-1), p<0.001; α-GST: 0.14±0.02 vs. 0.08±0.01 IU g(-1), p<0.001). Tissue caspase-3 expression in the small liver remnant group correlated with both AST and α-GST levels adjusted per gram of liver remnant (r2=0.51, p=0.005 and r2=0.71, p<0.001, respectively). Significant correlations between postoperative portal hypertension and the same markers as well as caspase-3 activity were also demonstrated. CONCLUSION: Liver remnants less than 30% of standard liver weight are much more susceptible to ischemia/reperfusion injury than controls twice the size. Adjustment of serum markers of hepatocyte injury to the liver remnant weight depicts injury more accurately.
Authors: C Farantos; N Arkadopoulos; K Theodoraki; G Kostopanagiotou; K Katis; K Tzavara; I Andreadou; K Dimopoulou; E Hatzoudi; T Sidiropoulou; I Skalkidis; A Paphiti; V Smyrniotis Journal: Eur Surg Res Date: 2008-02-26 Impact factor: 1.745
Authors: Kim Erlend Mortensen; Lene Nagstrup Conley; Jakob Hedegaard; Trine Kalstad; Peter Sorensen; Christian Bendixen; Arthur Revhaug Journal: Am J Physiol Gastrointest Liver Physiol Date: 2008-01-10 Impact factor: 4.052
Authors: Alexander Choukér; André Martignoni; Rolf J Schauer; Martin Dugas; Thomas Schachtner; Ines Kaufmann; Florian Setzer; Horst G Rau; Florian Löhe; Karl W Jauch; Klaus Peter; Manfred Thiel Journal: World J Surg Date: 2005-04 Impact factor: 3.352
Authors: B Aussilhou; M Lesurtel; A Sauvanet; O Farges; S Dokmak; N Goasguen; A Sibert; V Vilgrain; J Belghiti Journal: J Gastrointest Surg Date: 2007-11-30 Impact factor: 3.452
Authors: Xiao Xu; Kwan Man; Shu Sen Zheng; Ting Bo Liang; Terence K Lee; Kevin T Ng; Sheung Tat Fan; Chung Mau Lo Journal: Liver Transpl Date: 2006-04 Impact factor: 5.799