Hepatectomy: Preoperative Analysis of Hepatic Function and Postoperative Liver Failure

1998 ◽  
Vol 15 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Heinz Zimmermann ◽  
Jürg Reichen
Keyword(s):  
Liver Failure ◽  
Hepatic Function ◽  
Postoperative Liver Failure ◽  
Preoperative Analysis

Η αξιολόγηση της κάθαρσης του πράσινου της ινδοκυανίνης (ICG) προεγχειρητικά ως μέθοδος ελέγχου της ηπατικής λειτουργίας μετά ηπατεκτομή

2013 ◽  
Author(s):  
Μιχαήλ Δέρπαπας
Keyword(s):  
Liver Function ◽  
Liver Failure ◽  
Vena Cava ◽  
Normal Liver ◽  
Postoperative Liver Failure ◽  
Remnant Liver ◽  
Total Blood ◽  
Hepatic Reserve ◽  
Icg Clearance ◽  
Residual Liver Function

Purpose: Liver failure is a major cause of early mortality followinghepatectomy. The future-remnant liver function is an important factor whenassessing the risk for postoperative liver impairment. Several techniques havebeen established for this evaluation, including the ICG test. Aim of the study isto evaluate the ICG clearance in patients scheduled for liver resectionregarding perioperative and postoperative risk factors.Methods: Thirty-one patients, scheduled for liver resection, underwent theICG test. Peri-operative and postoperative variables were recorded andanalyzed using non-parametric tests.Results: Procedures extended from wedge excisions to extendedhepatectomies. Major complications included 1 case of a non-ST elevationmyocardial infarct, 1 case of inferior vena cava thrombosis, 2 cases of liverinsufficiency and 1 case of renal failure. Two patients died due to myocardialinfarction and postoperative liver failure respectively. PDR was foundpositively correlated with total blood loss, transfusion and operation duration.Conclusions: The role of residual liver function and particularly the hepaticreserve assessment on liver surgery may be of most benefit in the routinestratification of risk, enabling surgical procedures to be performed with safety.In this study, the ICG clearance markers were found significantly correlated with perioperative risk factors in histologically „normal‟ liver parenchyma.Interpretation of ICG clearance results may appraise in these patients aninadequate hepatic reserve in the remaining parenchyma postoperatively.Thus, in addition to CT volumetry, functional assessment of the hepaticreserve with ICG may persuade the preoperative planning and preventpostoperative liver failure.

Relationship between platelet count and hepatic failure and residual liver regeneration after hemihepatectomy in patients with hepatitis B-related primary hepatocellular carcinoma

2019 ◽  
Author(s):  
Chuhui Ye ◽  
Banghao Xu ◽  
Kaiyi Lu ◽  
Tingting Lu ◽  
Ling Zhang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Hepatitis B ◽  
Liver Failure ◽  
Liver Regeneration ◽  
Liver Volume ◽  
Primary Hepatocellular Carcinoma ◽  
Postoperative Liver Failure ◽  
Regeneration Rate ◽  
Significant Difference

Abstract Objective A retrospective analysis of the influences of platelet (PLT) counts on liver failure and liver regeneration in patients with primary hepatocellular carcinoma (HCC) provides a treatment strategy for clinical prevention and treatment of postoperative liver failure and residual liver regeneration. Method The clinical data of 111 patients with a background of hepatitis B virus infection and who underwent (expanded) half liver resection at the First Affiliated Hospital of Guangxi Medical University from June 2012 to June 2017 were collected and statistically analyzed. Results　On the basis of the International Study Group of Liver Surgery liver failure-grading standards and Dino–Clavien postoperative complication criteria, the incidence of grade B and above liver failure was 55%, and complication II level and above was 47.5% in the PLT decline group after semihepatectomy. The incidence rates in the normal group were 26.8% and 23.9%. A statistically significant difference was determined in the two groups (P1=0.003, P2 = 0.011). The average volumes of liver hyperplasia (residual liver volume (RLV)80.4 days − RLV) in the PLT decline and normal groups were 132.09 ± 61.89 cm3 and 190.89 ± 91.98c cm3, respectively; the average rates of hyperplasia ((RLV80.4days−RLV)/RLV) were 16.59%± 7.36% and 24.78% ± 10.82%. The difference between the two groups was statistically significant (PProliferation = 0.001, PProliferation rate = 0.001). Univariable and multivariable logistic regression analyses of postoperative liver failure grade and proliferation rate in patients who underwent semihepatectomy suggested that the decrease in postoperative PLT count (PLT < 125 × 109/L) might be an independent risk factor of severe posthepatectomy liver failure (PHLF) (PHLF-B or above) and residual liver regeneration rate for patients with primary HCC after half liver resection. No death occurred. Conclusions A correlation existed between PLT count and postoperative PHLF or liver regeneration. Monitoring PLT counts after liver resection may help us predict the suffering from PHLF-B or above and severe postoperative complications.

Liver failure under valproic acid

2011 ◽  
Vol 26 (S2) ◽  
pp. 1282-1282
Author(s):  
C. Schönfeldt-Lecuona ◽  
B.J. Connemann ◽  
R.W. Freudenmann ◽  
C. Hiemke ◽  
M.M. Schmid
Keyword(s):  
Valproic Acid ◽  
Side Effects ◽  
Liver Failure ◽  
Liver Enzymes ◽  
Bipolar Affective Disorder ◽  
Hepatic Function ◽  
Good Tolerability ◽  
Medical Products ◽  
Federal Institute

Valproic acid (VPA, 2-propylvaleric acid) is originally an antiepileptic drug, which has been in use for more than 30 years in over 100 countries. The clinical application of VPA has expanded in the last years. Approval has been granted by the FDA for treatment of migraine and cluster headache in 1996, and for treatment of mania and long-term prophylaxis of bipolar affective disorder in 1995. In ongoing studies, VPA has been reported to inhibit growth of several types of cancer cells; in addition, effects on neurodegeneration, and on virus replication in HIV infection have been demonstrated potentially expanding the application of VPA in the future. Despite a good tolerability of the drug, reports of hepatotoxicty even in patients without risk factors become more frequent. We analysed all cases of VPA induced severe hepatic side effects reported to the german Federal Institute for Pharmaceuticals & Medical Products (BfArM) between 1993 and 2009. A special intention was to detect correlations with present co-medication as a crucial factor in the break-down of hepatic function. As frequent co-medications in VPA-induced hepatic side effects benzodiazepines, and antiepileptics, especially carbamazepine, lamotrigine and topiramate were found. In addition, propofol as a co-medication was found in 4 lethal cases. Different pathomechanisms of VPA hepatotoxicity and a therapeutic approach with carnitine are discussed. Current international guidelines for prevention of VPA-induced liver failure are contrasted. Weekly control of liver enzymes in the first treatment weeks might help to detect VPA-induced hepatic side effects earlier.

Treatment for postoperative liver failure after major hepatectomy under hepatic total vascular exclusion

2003 ◽  
Vol 6 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Yoshihiro Asanuma ◽  
Tsutomu Sato ◽  
Ouki Yasui ◽  
Toshiaki Kurokawa ◽  
Kenji Koyama
Keyword(s):  
Liver Failure ◽  
Major Hepatectomy ◽  
Postoperative Liver Failure ◽  
Vascular Exclusion ◽  
Total Vascular Exclusion

Portal Inflow Modulation by Somatostatin During Major Liver Resection With a High Risk of Postoperative Liver Failure

2018 ◽  
Vol 267 (6) ◽  
pp. e104
Author(s):  
Ricardo Robles-Campos ◽  
Roberto Brusadin ◽  
Asunción López-Conesa ◽  
Victor López-López ◽  
Pascual Parrilla
Keyword(s):  
Liver Resection ◽  
High Risk ◽  
Liver Failure ◽  
Postoperative Liver Failure ◽  
Major Liver Resection
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