Small liver remnants are more vulnerable to ischemia/reperfusion injury after extended hepatectomies: a case-control study.

Abstract

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: Kassiani Theodoraki, Nikolaos Arkadopoulos, Constantinos Nastos, Ioannis Vassiliou, Iosifina Karmaniolou, Vassilios Smyrniotis
• Journal: World journal of surgery (World J Surg) Vol. 36 Issue 12 Pg. 2895-900 (Dec 2012) ISSN: 1432-2323 [Electronic] United States
• PMID: 22956015 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Biomarkers
• Isoenzymes
• Glutathione Transferase
• glutathione S-transferase alpha
• Aspartate Aminotransferases
• Caspase 3

Topics

• Aged
• Aspartate Aminotransferases (blood)
• Biomarkers (metabolism)
• Case-Control Studies
• Caspase 3 (metabolism)
• Female
• Glutathione Transferase (blood)
• Hepatectomy
• Humans
• Hypertension, Portal (enzymology, etiology)
• Isoenzymes (blood)
• Liver (anatomy & histology, enzymology, surgery)
• Male
• Middle Aged
• Organ Size
• Postoperative Complications (enzymology)
• Reperfusion Injury (diagnosis, enzymology, etiology)