The costs of postoperative liver failure and the economic impact of liver function capacity after extended liver resection—a single-center experience

Lock, Johan Friso; Reinhold, Thomas; Malinowski, Maciej; Pratschke, Johann; Neuhaus, P.; Stockmann, Martin

doi:10.1007/s00423-009-0518-4

Cited by 44 publications

(42 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The regenerative ability of the liver is an essential precondition for the successful application of a partial hepatectomy or LDLT (Kellersmann et al, 2002;Topal et al, 2003). Nevertheless, in the absence of regeneration, delayed or decelerated liver regeneration results in complications such as postoperative liver failure, which remains the major cause of postoperative mortality, septic infections, bleeding, hepatic encephalopathy, and renal failure (Schneider, 2004;van den Broek et al, 2008;Lock et al, 2009). Therefore, therapeutic interventions that can facilitate liver regeneration after resection are of clinical importance.…”

Section: Discussionmentioning

confidence: 99%

“…The ability of the remaining hepatocytes to regenerate determines survival after surgery. In the absence of regeneration, delayed or decelerated liver regeneration results in serious complications such as postoperative liver failure, which remains an important clinical problem (Lock et al, 2009;Kawaguchi et al, 2013). Thus, timely onset of liver regeneration plays a crucial role in recovery and survival after liver resection.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Schisandra sphenanthera Extract Facilitates Liver Regeneration after Partial Hepatectomy in Mice

Fan

et al. 2016

Drug Metabolism and Disposition

View full text Add to dashboard Cite

Liver regeneration after surgical liver resection is crucial for the restoration of liver mass and the recovery of liver function. Schisandra sphenanthera extract (Wuzhi tablet, WZ) is a preparation of an extract from the dried ripe fruit of Schisandra sphenanthera Rehd. et Wils, a traditional hepatoprotective herb. Previously, we found that WZ could induce liver regeneration-related genes against acetaminopheninduced liver injury. However, whether WZ can directly facilitate liver regeneration after liver resection remains unknown. We investigated whether WZ has potential in promoting liver regeneration after a partial hepatectomy (PHX) in mice. Remnant livers were collected 1, 1.5, 2, 3, 5, 7, and 10 days after PHX. Hepatocyte proliferation was assessed using the Ki-67 labeling index. Western blot analysis was performed on proteins known to be involved in liver regeneration. The results demonstrated that WZ significantly increased the liver-to-body weight ratio of mice after PHX but had no effect on that of mice after a sham operation. Additionally, the peak hepatocyte proliferation was observed at 1.5 days in PHX/WZ-treated mice but at 2 days in PHX/saline-treated mice, as evidenced by the Ki-67 positive ratio. Furthermore, WZ significantly increased the protein expression of ligand-induced phosphorylation of epidermal growth factor receptor and up-regulated cyclin D1, cyclin D-dependent kinase 4, phosphorylated retinoblastoma, and proliferating cell nuclear antigen protein expression and down-regulated the expression of cell cycle inhibitors p21 and p27 in the regenerative process after PHX. These results demonstrate that WZ significantly facilitates hepatocyte proliferation and liver regeneration after PHX.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Schisandra sphenanthera Extract Facilitates Liver Regeneration after Partial Hepatectomy in Mice

Fan

et al. 2016

Drug Metabolism and Disposition

View full text Add to dashboard Cite

show abstract

“…Inasmuch as I/R injury also impairs liver regeneration, the ability to recover from surgery is further suppressed (19). If these effects persist, the ultimate consequence of I/R injury is postoperative liver failure, which is the most severe complication of liver surgery and is associated with high medical costs and a mortality rate of up to 88% (20).…”

Section: Nadmentioning

confidence: 99%

Protective Mechanisms of Hypothermia in Liver Surgery and Transplantation

Olthof

Reiniers

Dirkes

et al. 2015

Mol Med

View full text Add to dashboard Cite

Hepatic ischemia/reperfusion (I/R) injury is a side effect of major liver surgery that often cannot be avoided. Prolonged periods of ischemia put a metabolic strain on hepatocytes and limit the tolerable ischemia and preservation times during liver resection and transplantation, respectively. In both surgical settings, temporarily lowering the metabolic demand of the organ by reducing organ temperature effectively counteracts the negative consequences of an ischemic insult. Despite its routine use, the application of liver cooling is predicated on an incomplete understanding of the underlying protective mechanisms, which has limited a uniform and widespread implementation of liver-cooling techniques. This review therefore addresses how hypothermia-induced hypometabolism modulates hepatocyte metabolism during ischemia and thereby reduces hepatic I/R injury. The mechanisms underlying hypothermia-mediated reduction in energy expenditure during ischemia and the attenuation of mitochondrial production of reactive oxygen species during early reperfusion are described. It is further addressed how hypothermia suppresses the sterile hepatic I/R immune response and preserves the metabolic functionality of hepatocytes. Lastly, a summary of the clinical status quo of the use of liver cooling for liver resection and transplantation is provided.

show abstract

“…Aufgrund fehlender valider Daten kann aber bisher keine pharmakologische Strategie für die Routinetherapie empfohlen werden [43,45]. [46,47]. Risikofaktoren sind große Parenchymverluste, große intraoperative Blutverluste und eine längere vaskuläre Okklusion.…”

Section: Disclosure Statementunclassified

Leberresektionen – was ist perioperativ zu beachten?

Kaffarnik¹,

Lock²,

Seehofer³

et al. 2011

Viszeralmedizin

View full text Add to dashboard Cite

Leberresektionen sind heute Standardoperationen bei malignen und benignen Tumoren. Mit der Entwicklung neuer Resektionstechniken und Anästhesieverfahren konnte die Komplikationsrate gesenkt werden. Es gibt aber weiterhin spezifische Komplikationen, auf die im perioperativen Management besonders geachtet werden muss. Dazu zählen die Beeinträchtigung der Gerinnung, Galleleckagen, der Ischämie-/Reperfusionsschaden und das Leberversagen. Präoperative Verfahren zur Einschätzung der Leberfunktion, wie z.B. der LiMAx-Test (Maximal Liver Function Capacity), und des sich daraus ergebenden möglichen Resektionsausmaßes gehören heute zur Routinediagnostik. Sie werden auch postoperativ zum Monitoring der Restleberfunktion eingesetzt. Mit diesen Verfahren können Hochrisikopatienten bereits im Vorfeld erkannt und mögliche Komplikationen durch eine Risikostratifizierung minimiert werden. Die postoperative Therapie ist ein weiterer wichtiger Baustein der Leberchirurgie. Ein differenziertes perioperatives Volumen-, Schmerz- und Antikoagulationsmanagement ist mitentscheidend für das therapeutische Ergebnis. Hinzu kommt ein früher enteraler Kostaufbau unter Berücksichtigung etablierter Standards der perioperativen Ernährung. Damit kann das Auftreten pulmonaler und infektiologischer Komplikationen bis hin zur Sepsis vermindert werden.

show abstract

The costs of postoperative liver failure and the economic impact of liver function capacity after extended liver resection—a single-center experience

Abstract: PLF is a very relevant medical and economic problem. Liver function capacity does not only predict PLF but also correlates with total costs in general.

Cited by 44 publications

References 27 publications

Schisandra sphenanthera Extract Facilitates Liver Regeneration after Partial Hepatectomy in Mice

Schisandra sphenanthera Extract Facilitates Liver Regeneration after Partial Hepatectomy in Mice

Protective Mechanisms of Hypothermia in Liver Surgery and Transplantation

Leberresektionen – was ist perioperativ zu beachten?

Contact Info

Product

Resources

About