Regeneration of Liver Function Capacity After Partial Liver Resection is Impaired in Case of Postoperative Bile Leakage

Abstract

These are the first data evaluating the impact of PBL on functional regeneration after liver surgery. Liver regeneration after partial liver resection is impaired by PBL. However, a nearly normal recovery is possible if the bile leak is diagnosed early and immediately treated. Moreover, patients presenting with delayed functional recovery in the postoperative course are likely to have complications, e.g., bile leakage.

Functional considerations in ALPPS – consequences for clinical management

“…Recently, we could show that bile leakage results in an impaired liver regeneration, which is a common complication between steps I and II and a major driver of morbidity and mortality in ALPPS. 26 A recent article of Linecker et al identified two surrogate parameters for liver failure prior to step II, bilirubin and creatinine, as independent predictors of fatal outcome after completion of ALPPS. 27 Taken together, the substantial impairment of liver function after step I and the lack of functional regeneration until step II might be the major source of morbidity and mortality in ALPPS.…”

“…A possible explanation might be that bile duct problems after step I, which are typically associated with poorer outcome and impaired function were only present in four patients of our cohort. 26 In addition, it might be of major importance that most patients were evaluated for resectability with respect to liver function measured by the LiMAx test before step II. Relevant problems during the interstage time interval could be detected by inadequate regeneration of the LiMAx.…”

In search of a pathogenesis for impaired liver regeneration after major hepatectomy with extrahepatic bile duct resection: The plot thickens!

“…Thus, the surgical invasiveness and morbidity became suspected of being a potential pathogenic mechanism sustaining the postoperative impairment of vLR. It has been also reported that the development of a post‐hepatectomy biliary leak has a negative impact on the regeneration of dynamic liver function capacity, as assessed by LiMAx test . Likewise, it has been shown in an experimental rat model that the addition of choledochojejunostomy to 70% partial hepatectomy is associated with a significant increase of intrahepatic inflammatory reaction, resulting in a significantly downregulated expression of liver regeneration‐promoting genes (hepatocyte growth factor and epidermal growth factor) .…”

“…It has been also reported that the development of a post-hepatectomy biliary leak has a negative impact on the regeneration of dynamic liver function capacity, as assessed by LiMAx test. 11 Likewise, it has been shown in an experimental rat model that the addition of choledochojejunostomy to 70% partial hepatectomy is associated with a significant increase Hepatology Research 2019; 49: 1091-1093 doi: 10.1111/hepr.13414 of intrahepatic inflammatory reaction, resulting in a significantly downregulated expression of liver regeneration-promoting genes (hepatocyte growth factor and epidermal growth factor). 12 The suspected underlying trigger was the development of cholangitis induced by jejunobiliary reflux, as a previous study also noted that experimentally-induced segmental cholangitis in rats impaired LR.…”

Randomized clinical trial comparing liver resection with and without perioperative assessment of liver function

“…Since the first experimental application of the LiMAx ® test in 2004, its diagnostic accuracy and clinical potential have been shown in several clinical fields, including surgery, transplantation medicine, intensive care and hepatology. The LiMAx ® test accurately determines liver function before and after liver surgery. A retrospective analysis showed a striking decrease of postoperative liver failure and postoperative liver failure‐related mortality following implementation of the LiMAx ® algorithm.…”