Quantitative Assessment of Hepatic Function and its Relevance to the Liver Surgeon

Morris‐Stiff, Gareth; Gomez, Dhanny; Prasad, Raj

doi:10.1007/s11605-008-0564-1

Cited by 49 publications

(34 citation statements)

References 87 publications

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“…An insufficient hepatic function of the remnant hepatic parenchyma is one of the main contributing factors to postoperative mortality in hepatic resection [2]. Traditional methods for the measurement of hepatic function include a hepatic volumetry [3], indocyanine green (ICG) clearance test, and clinical scoring system such as Child-Pugh score and the Model of End Stage Liver Disease (MELD) score [4]. However, these measurements offer the global assessment not the regional parenchymal assessment of hepatic function.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Hepatic Function with Gd-EOB-DTPA-Enhanced Hepatic MRI

Bae

Kim²,

Lee³

et al. 2012

Dig Dis

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Assessment of hepatic function is essential in determining the prognosis and clinical management of a patient who has chronic liver disease or undergoes liver surgery. For a patient with locally varying hepatic parenchymal abnormalities, a regional assessment of hepatic function mapped onto hepatic anatomy is clinically more meaningful than conventional global metrics of hepatic function. Of late, hepatic magnetic resonance imaging has been increasingly used because of its superb tissue contrast and delineation of hepatic morphology and underlying abnormalities. The introduction of hepatocyte-specific contrast agents such as Gd-EOB-DTPA allows us to view not only the hepatic anatomy but also assess regional hepatic function. In this article, we review and discuss recently published studies that used Gd-EOB-DTPA-enhanced magnetic resonance imaging to evaluate hepatic function.

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Section: Introductionmentioning

confidence: 99%

Assessment of Hepatic Function with Gd-EOB-DTPA-Enhanced Hepatic MRI

Bae

Kim²,

Lee³

et al. 2012

Dig Dis

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“…Postoperative clinical outcome, morbidity, and mortality depend on an efficient regeneration of the liver after these operations. Liver failure is the cause of major complications when the small remnant liver volume cannot sustain the postoperative metabolic and synthetic demands [3,4,5]. Therefore, reducing liver injury and promoting hepatocyte growth and viability, especially after subtotal hepatectomy (SH) are important clinical issues.…”

Section: Introductionmentioning

confidence: 99%

Vascular Endothelial Growth Factor Improves Liver Regeneration and Survival after 90% Hepatectomy in a Rat Model of Diet-Induced Steatosis

Gu¹,

Sowa

Paul³

et al. 2013

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Background/Aims: Fatty liver disease increases the risk in major liver resection for patients. As previous studies suggested that vascular endothelial growth factor (VEGF) and erythropoietin (EPO) might improve liver regeneration in nonobese animals, we investigated their effect after subtotal hepatectomy (SH) in rats with diet-induced steatosis. Methods: Male Wistar rats were fed with fatty liver-inducing diet (FLD) or normal diet (control) for 11-12 weeks followed by 90% SH. Animals were treated either with EPO, VEGF or NaCl on postoperative days 0, 1 and 3 and sacrificed 24 h or 7 days after SH. Survival rate, liver regeneration and biochemical markers were assessed. Expression of inflammatory cytokines (TNF-α, IL-6) and apoptosis-related genes (PUMA, Bcl-2) was measured by qRT-PCR. Results: Seven-day survival after SH was significantly decreased in the FLD group compared to controls (50 vs. 100%, p < 0.05). In FLD animals, treatment with VEGF increased 7-day survival to 90% compared to only 40% in the EPO group. After surgery, blood glucose levels of VEGF but not EPO- or NaCl-treated animals remained normal. Inflammatory genes were markedly upregulated in the EPO group 24 h after SH. Conclusions: Steatosis severely impairs survival and regeneration after extensive liver resection, which can be counteracted at least in part by perioperative treatment with VEGF.

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“…Currently, surgical decision-making is predominantly based on volume calculation from cross-sectional imaging, sometimes in combination with liver function evaluation [4,5]. A variety of different methods for quantitative assessment of global liver function are available, including clearance-retention tests, redox chemistry and scintigraphy [6,7]. All currently available metabolic tests give a global assessment of liver function and do not account or correct for the possible heterogeneous distribution of function within the liver parenchyma.…”

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confidence: 99%