Effect of Liver Resection-induced Increases in Hepatic Venous Pressure Gradient on Development of Postoperative Acute Kidney Injury

Abstract

Background: The impact of changes in portal pressure before and after liver resection (defined as ΔHVPG) on postoperative renal function remains unknown. Therefore, we investigated the effect of ΔHVPG on (i) the incidence of postoperative AKI and (ii) the renin-angiotensin system (RAAS) and sympathetic nervous system (SNS) activity. Methods: We included 30 patients undergoing partial liver resection. Our primary outcome was postoperative AKI according to KDIGO criteria. For our secondary outcome we assessed the plasma renin, aldosterone, noradrenaline, adrenaline, dopamine and vasopressin concentrations prior and 2 hours after induction of anaesthesia, on the first and fifth postoperative day. HVPG was measured prior and immediately after liver resection.Results: ΔHVPG could be measured in 21 patients with 12 patients HVPG showing increases in HVPG (∆HVPG≥1mmHg) while 9 patients remained stable. AKI developed in 7/12 of patients with increasing HVPG, but only in 2/9 of patients with stable DHVPG (p=0.302). Noradrenalin levels were significantly higher in patients with increasing DHVPG than in patients with stable DHVPG. (p=0.009). Biomarkers reflecting RAAS and SNS activity remained similar in patients with increasing vs. stable DHVPG. Conclusions: Patients with increasing HVPG were more likely to develop postoperative AKI as compared those with stable HVPG values.

The efficacy of contrast-enhanced computed tomography on the management of gastroesophageal varices in patients with hepatocellular carcinoma

“…More patients in the early stage of HCC had undergone liver resection (27.2%) compared to 12.7% in the intermediate-advanced stage of HCC (p = 0.003). As previously demonstrated, liver resection causes worsened portal hypertension 21,22 . This simple but reasonable explanation may account for the deterioration of GEV in the early stage of HCC and the patients with HCC who received potentially curative treatment.…”