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New Paradigms in Post-hepatectomy Liver Failure

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Liver failure after hepatectomy remains the most feared postoperative complication. Many risk factors are already known, related to patient’s comorbidities, underlying liver disease, received treatments and type of resection. Preoperative assessment of functional liver reserve must be a priority for the surgeon.

Methods

Physiopathology of post-hepatectomy liver failure is not comparable to fulminant liver failure. Liver regeneration is an early phenomenon whose cellular mechanisms are beginning to be elucidated and allowing most of the time to quickly recover a functional organ. In some cases, microscopic and macroscopic disorganization appears. The hepatocyte hyperproliferation and the asynchronism between hepatocytes and non-hepatocyte cells mitosis probably play a major role in this pathogenesis.

Results

Many peri- or intra-operative techniques try to prevent the occurrence of this potentially lethal complication, but a better understanding of involved mechanisms might help to completely avoid it, or even to extend the possibilities of resection.

Conclusion

Future prevention and management may include pharmacological slowing of proliferation, drug or physical modulation of portal flow to reduce shear–stress, stem cells or immortalized hepatocytes injection, and liver bioreactors. Everything must be done to avoid the need for transplantation, which remains today the most efficient treatment of liver failure.

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Abbreviations

HGF:

Hepatocyte growth factor

ICG:

Indocyanine green

ICG 15′:

ICG clearance test (plasmatic retention at 15 min)

LSEC:

Liver sinusoidal endothelial cells

OLT:

Orthotopic liver transplantation

PHLF:

Post-hepatectomy liver failure

PHT:

Portal hypertension

PHx:

Partial hepatectomy

POD:

Postoperative day

PVE:

Portal vein embolization

RL:

Remnant liver

TGF:

Transforming growth factor

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  1. Centre Hépatobiliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris XI, Paris, France

    Nicolas Golse, Petru O. Bucur, René Adam, Denis Castaing, Antonio Sa Cunha & Eric Vibert

  2. Inserm, Unité 785, Villejuif, 94800, France

    Eric Vibert

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  1. Nicolas Golse
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Golse, N., Bucur, P.O., Adam, R. et al. New Paradigms in Post-hepatectomy Liver Failure. J Gastrointest Surg 17, 593–605 (2013). https://doi.org/10.1007/s11605-012-2048-6

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