Measurement of Serum Hyaluronate as a Predictor of Human Liver Failure after Major Hepatectomy

Abstract

Serum hyaluronate can be used as an index of hepatic sinusoidal endothelial cell function. This study was designed to evaluate its application as a predictor of liver failure after major hepatectomy. Thirty-six patients who underwent right liver lobectomy after percutaneous transhepatic right branch portal vein embolization were divided into two groups based on their postoperative clinical course (groups 1 and 2, with and without postoperative liver failure, n = 6 and n = 30, respectively). We serially measured serum hyaluronate levels using a sandwich binding protein assay system before and after hepatectomy and determined relations with progression of the underlying chronic liver disorder, portal venous pressure, and liver growth of the left lobe after portal embolization. Serum hyaluronate levels were significantly elevated, in line with the degree of severity of the underlying chronic liver disorder, and correlated well with the portal venous pressure and the hypertrophic ratio of the left lobe subsequent to portal embolization. Serum hyaluronate levels in group 1 were significantly higher than those in group 2 before surgery and increased steeply during the early period after hepatectomy. These results suggest that the serum hyaluronate reflects the hepatic functional reserve, and serial measurement of this parameter after hepatectomy can serve as a simple indicator for early detection of posthepatectomy liver failure.

Comprehensive Predictors of Portal Pressure from Functional Liver Reserve in Patients Who Underwent Hepatectomy

“…The present study applied the reliable liver function markers from 99m Tc-GSA liver scintigraphy, ICGR15, and serum HA level, along with conventional parameters [12,13,16,17]. These noninvasive tests can be routinely performed before hepatectomy.…”

“…Peripheral blood samples for serum HA level were collected from every patient, and HA was assayed using the sandwich-binding protein assay (SRL, Tokyo, Japan). The normal value of serum HA is ≤50 ng/ml [12,16,17]. We performed histological staging using Knodell's score [18].…”

“…The present study examined relationships between reliable parameters of functional liver reserve such as conventional liver function tests, the indocyanine green (ICG) clearance test [11], serum hyaluronic acid (HA) level [12], and 99m Tc-galactosyl human serum albumin liver scintigraphy ( 99m Tc-GSA scintigraphy) [13] in 93 patients with various liver diseases in whom PP was directly measured. Furthermore, we attempted to derive a comprehensive analytical formula by multivariate analysis to predict PP and then compared predictive PP and true PP.…”

Prediction of portal pressure from intraoperative ultrasonography

“…Tc-GSA scintigraphy and PP [25], suggesting that HH15 and LHL15 are reliable predictors of PP. Serum HA is a marker of hepatic fibrosis and the deserialization of endothelial cell function in the liver [13], which reflect post-hepatectomy complications, such as hepatic failure [13,26] that was caused by portal hypertension. However, in the small size of the present series, these parameters were not well correlated with PP.…”

“…The accuracy of determining the flow Doppler by IOUS is high (4,5). The flow Doppler's ultrasonographic parameters reflect the dynamics of the hepatic inflow and outflow, which may be associated with both the PP and the background liver status [13,14]. To the best of our knowledge, no indirect prediction of PP using ultrasonographic parameters has yet been reported.…”