A Case of refractory hepatic encephalopathy with poor residual liver function effectively treated with trans-ileocolic venous obliteration (TIO) using Doppler ultrasonography

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.

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Reversal of portal blood flow after distal splenorenal shunt (DSRS). Relationship to hepatic encephalopathy and impaired liver function

Journal of Hepatology ◽

10.1016/0168-8278(89)90460-1 ◽

1989 ◽

Vol 9 ◽

pp. S142 ◽

Cited By ~ 3

Author(s):

AM DeLacy ◽

M Navasa ◽

JC García-Pagán ◽

C Bru ◽

F Feu ◽

...

Keyword(s):

Blood Flow ◽

Hepatic Encephalopathy ◽

Liver Function ◽

Portal Blood Flow ◽

Portal Blood ◽

Splenorenal Shunt ◽

Distal Splenorenal Shunt ◽

Impaired Liver Function ◽

Impaired Liver

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Assessment of liver function: pre- and peritransplant evaluation

Clinical Chemistry ◽

10.1093/clinchem/43.8.1539 ◽

1997 ◽

Vol 43 (8) ◽

pp. 1539-1545 ◽

Cited By ~ 20

Author(s):

Abraham Shaked ◽

Fredrick A Nunes ◽

Kim M Olthoff ◽

Michael R Lucey

Keyword(s):

Liver Function ◽

Graft Function ◽

Terminal Condition ◽

High Rate ◽

Liver Graft ◽

Therapeutic Modality ◽

Donor Liver ◽

Laboratory Assessment ◽

Residual Liver Function ◽

End Stage

Abstract Liver transplantation has been demonstrated to be a successful therapeutic modality for patients with end-stage liver disease. The high rate of survival for an otherwise terminal condition has resulted in significant expansion of the indications and diseases treated by this procedure, and is hampered only by the limited numbers of organs available for transplantation. Efforts in clinical and laboratory medicine should be directed to identify candidates who would benefit most from this procedure, to provide better means for accurate assessment of liver reserve and the appropriate timing for transplantation, to identify quality liver grafts that would have the potential to tolerate cold preservation and reperfusion injury, and to assist in accurate monitoring of graft function immediately after transplantation. The aim of this manuscript is to describe the existing pathways for clinical and laboratory assessment of pretransplant residual liver function, the donor liver graft, and immediate posttransplantation function.

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Management of Transjugular Intrahepatic Portosystemic Shunt (TIPS)-associated Refractory Hepatic Encephalopathy by Shunt Reduction Using the Parallel Technique: Outcomes of a Retrospective Case Series

Yearbook of Diagnostic Radiology ◽

10.1016/j.yrad.2011.02.047 ◽

2011 ◽

Vol 2011 ◽

pp. 211-216

Author(s):

T.G. Walker

Keyword(s):

Hepatic Encephalopathy ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Case Series ◽

Portosystemic Shunt ◽

Retrospective Case ◽

Retrospective Case Series ◽

Intrahepatic Portosystemic Shunt ◽

Refractory Hepatic Encephalopathy ◽

Parallel Technique

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Relationships between MELD scoring system, Child-Pugh's score, and residual liver function in a European series of cirrhotic patients

Journal of Hepatology ◽

10.1016/s0168-8278(02)80147-7 ◽

2002 ◽

Vol 36 ◽

pp. 47

Author(s):

Federica Botta ◽

Edoardo Giannini ◽

Paola Romagnoli ◽

Alberto Fasoli ◽

Federica Malfatti ◽

...

Keyword(s):

Liver Function ◽

Scoring System ◽

Cirrhotic Patients ◽

Residual Liver Function

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Quantitative rat liver function test by galactose single point method

Laboratory Animals ◽

10.1258/la.2007.06040e ◽

2008 ◽

Vol 42 (4) ◽

pp. 495-504 ◽

Cited By ~ 6

Author(s):

T H Young ◽

H S Tang ◽

Y C Chao ◽

H S Lee ◽

C H Hsiong ◽

...

Keyword(s):

Liver Function ◽

Liver Function Test ◽

Rat Liver ◽

Activity Index ◽

Single Point ◽

Nitrophenyl Phosphate ◽

The Us ◽

Function Test ◽

Histological Activity ◽

Residual Liver Function

Summary The purpose of this study was to investigate the galactose single point (GSP) method, a residual liver function test recently recommended by the US Food and Drug Administration, which can be a useful tool for rat liver function measurement. Rats were treated either with carbon tetrachloride (CCl4) alone (1 mL/kg, intraperitoneally [i.p.]) for one day or with isoniazid (INH) alone (150 mg/kg, i.p.) or (in order to ameliorate the effects of INH) with a combination of INH and bis- p-nitrophenyl phosphate (BNPP) (25 mg/kg, i.p.) for 21 days. Hepatotoxicity was assayed by plasma aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities and scores of histological activity index-necroinflammation (HAI-NI) of the respective liver specimens. The GSP method in rats was defined by the galactose blood level after 60 min. Significant differences in GSP values were observed between controls and the CCl4-treated rats. After 21 days of treatment, no significant changes in AST and ALT values were observed among the control, INH and INH-BNPP groups. There were significant differences in average GSP values for controls ( P < 0.001) and INH-BNPP ( P < 0.001) compared with INH alone. Highly significant correlations ( P < 0.001) were obtained between GSP and scores of HAI-NI for all the groups. GSP was concluded to be a more sensitive biomarker of INH-induced hepatotoxicity than AST or ALT in the rats. The GSP method has been proved to be a simple and useful tool for the quantitative determination of liver function in rats, which can possibly be extended to other animals.

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