Hepatic Steatosis Is a Risk Factor for Postoperative Complications After Major Hepatectomy

McCormack, Lucas; Petrowsky, Henrik; Jochum, Wolfram; Furrer, Katarzyna; Clavien, Pierre‐Alain

doi:10.1097/01.sla.0000251747.80025.b7

Cited by 285 publications

(247 citation statements)

References 36 publications

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“…The disease spectrum of NAFLD ranges from simple steatosis to nonalcoholic steatohepatitis (NASH), which can further progress into fibrosis, cirrhosis, and ultimately into endstage liver disease, posing a significant burden on liver transplantation waiting lists. Moreover, clinical studies identified severe macrovesicular steatosis (>66%) as an exclusion criterion for patients requiring major liver resection because of the concomitant high risk of postoperative complications (3,4). In living donor liver transplantation (LDLT) procedures steatosis is considered even more deleterious, posing a risk for both the donor and the recipient.…”

Section: Nonalcoholic Fatty Liver Disease (Nafld) Ismentioning

confidence: 99%

Noninvasive quantification of hepatic steatosis inrats using 3.0 T ¹H‐magnetic resonance spectroscopy

Marsman

Werven

Nederveen

et al. 2010

Magnetic Resonance Imaging

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H-MRS accurately distinguished mild from moderate and moderate from severe steatosis. Calculations using [AUC fat /AUC water ] ratio in severe steatotic livers resulted in higher hepatic fat percentages as compared to the other methods due to a decrease in hepatic water content. Conclusion:1 H-MRS quantification of hepatic fat content showed high correlations with histological and biochemical steatosis determination in an experimental steatosis rat model and accurately discriminated between clinically relevant steatosis degrees. These results encourage further application of 1 H-MRS in patients for accurate steatosis assessment.

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Section: Nonalcoholic Fatty Liver Disease (Nafld) Ismentioning

confidence: 99%

Noninvasive quantification of hepatic steatosis inrats using 3.0 T ¹H‐magnetic resonance spectroscopy

Marsman

Werven

Nederveen

et al. 2010

Magnetic Resonance Imaging

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“…The effect of hepatic steatosis on short term post operative outcomes has been widely investigated (9)(10)(11)(12)(13) . The general underlying theme in these studies seemed to indicate that patients with steatosis were susceptible to a more arduous post operative course with respect to complication rates and short term morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…The authors concluded that steatohepatitis is associated with an increased mortality after hepatectomy and the use of Irinotecan should be carefully considered. Recent studies reported steatosis as an independent factor for morbidity and mortality rates in patients undergoing hepatectomy (10,11,12) . Considering the pathophysiology and risk factors for steatohepatitis, and in view of the evidence given above, it would appear that hepatic steatosis and obesity are relative contraindications in patients undergoing hepatectomy for CRLM.…”

Section: Introductionmentioning

confidence: 99%

Hepatic steatosis, body mass index and long term outcome in patients undergoing hepatectomy for colorectal liver metastases

Pathak

Tang

Terlizzo

et al. 2010

European Journal of Surgical Oncology (EJSO)

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. M A N U S C R I P T A C C E P T E D ARTICLE IN PRESS

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“…Indication for blood transfusion was massive hemorrhage (> 1500 mL) within 24 to 48 hours after surgery. 10,11 All patients who developed postoperative hemorrhage underwent abdominal CT scans and were divided into 2 groups based on the CT findings. Patients who did not have contrast material extravasation were considered to have coagulopathic hemorrhage (n = 15), and patients who presented with extravasation of contrast material were considered to have noncoagulopathic hemorrhage (n = 17).…”

Section: Patients and Definitions Of Hemorrhage After Livingdonor LIVmentioning

confidence: 99%

Untitled

Hsieh

Chou²,

Lin³

et al. 2017

Exp Clin Transplant

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Objectives: Our goal was to evaluate the predictors of coagulopathic hemorrhage after living-donor liver transplant. Materials and Methods:We retrospectively evaluated 161 patients who had undergone living-donor liver transplant from July 2005 to April 2014 at a single medical institution. Of these patients, 32 developed hemorrhage after transplant. Patients were separated into those with coagulopathy-related hemorrhage (n=15) or noncoagulopathy-related hemorrhage (n=17) based on the results of computed tomography images. Predictors of hemorrhage after living-donor liver transplant evaluated in this study included preoperative, perioperative, and posttransplant factors and hemodynamic status. Results: Patients who developed coagulopathy-related hemorrhage had significantly lower pretransplant platelet counts (P = .040), a longer cold-ischemia time (P = .045), more blood loss (P = .040), and earlier onset of hemorrhage (P = .048) than patients who had noncoagulopathy-related hemorrhage after transplant. Results of the generalized estimating equation analysis showed that heart rate and central venous pressure differed significantly between the 2 groups of patients. Heart rates increased significantly during hemorrhage (P < .010). Central venous pressure was higher in the coagulopathic group (P = .005) than in the noncoagulopathic group. Conclusions: Lower pretransplant platelet counts, longer cold ischemia time, more blood loss, earlier onset of hemorrhage, and higher central venous pressure level are indicators of coagulopathic hemorrhage after living-donor liver transplant. Key words: Central venous pressure, Cold ischemia time, Computed tomography IntroductionHemorrhage is one of the most common complications after liver transplant, especially during the first postoperative week. 1,2 There are many factors that contribute to postoperative hemorrhage, including the recipient's preoperative condition (for example, coagulopathy, thrombocytopenia), liver graft condition (donors > 60 years, steatosis), surgical technique (inadequate hemostasis of the cut surface of the remnant liver, blood loss from vascular anastomosis, and prolonged cold ischemia time), and recipient's postoperative condition (early graft dysfunction or primary nonfunction, use of heparin, vascular complications). [3][4][5][6] Regardless of the underlying causes of hemorrhage, hemorrhage after liver transplant can be classified as coagulopathic bleeding (bleeding related to poor graft function and coagulopathy, resulting in continuous oozing of blood) or noncoagulopathic bleeding (bleeding in patients with normal coagulation function).Computed tomography (CT) has been reported to be a sensitive modality for detecting active bleeding in patients with major trauma.

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Hepatic Steatosis Is a Risk Factor for Postoperative Complications After Major Hepatectomy

Abstract: Steatosis per se is a risk factor for postoperative complications after major hepatectomy and should be considered in the planning of surgery. Caution must be taken to perform major hepatectomy in steatotic patients with preexisting cholestasis.

Cited by 285 publications

References 36 publications

Noninvasive quantification of hepatic steatosis inrats using 3.0 T ¹H‐magnetic resonance spectroscopy

Noninvasive quantification of hepatic steatosis inrats using 3.0 T ¹H‐magnetic resonance spectroscopy

Hepatic steatosis, body mass index and long term outcome in patients undergoing hepatectomy for colorectal liver metastases

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Hepatic Steatosis Is a Risk Factor for Postoperative Complications After Major Hepatectomy

Abstract: Steatosis per se is a risk factor for postoperative complications after major hepatectomy and should be considered in the planning of surgery. Caution must be taken to perform major hepatectomy in steatotic patients with preexisting cholestasis.

Cited by 285 publications

References 36 publications

Noninvasive quantification of hepatic steatosis inrats using 3.0 T 1H‐magnetic resonance spectroscopy

Noninvasive quantification of hepatic steatosis inrats using 3.0 T 1H‐magnetic resonance spectroscopy

Hepatic steatosis, body mass index and long term outcome in patients undergoing hepatectomy for colorectal liver metastases

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Noninvasive quantification of hepatic steatosis inrats using 3.0 T ¹H‐magnetic resonance spectroscopy

Noninvasive quantification of hepatic steatosis inrats using 3.0 T ¹H‐magnetic resonance spectroscopy