title: Clinicohistological features of liver failure after excessive hepatectomy.
abstract: OBJECTIVE
  Patients at high risk of liver failure sometimes suffer such failure with hyperbilirubinemia after hepatectomy. This report clarifies the clinicohistological findings in liver failure cases after excessive hepatectomy, and discusses the mechanisms of liver failure.
  
  
  METHODS
  Of 16 patients who suffered liver failure after hepatectomy between May 1992 and December 1999, 7 patients who underwent liver biopsy or autopsy were studied. The biopsy findings showed that, in each case, the percentages of hepatocytes that were apoptotic or binucleated were calculated. The number of bile plugs per 1000 micron 2 was counted and the thickness of collagen fibers in Disse's space was measured at 10 sites. The total bilirubin level was monitored over time, and the triggers, other than excessive hepatectomy, of increases in the bilirubin level were investigated.
  
  
  RESULTS
  From the histological findings, liver failure cases were classified into cholestatic and nonregenerative types. Regeneration of hepatocytes and fibrosis in Disse's space were characteristic of the cholestatic type, while apoptosis of hepatocytes was characteristic of the nonregenerative type. Other than excessive hepatectomy, postoperative infection was the only trigger of liver failure in the cholestatic type, and ischemic changes of the liver resulted in liver failure in the nonregenerative type. The total bilirubin level changed more slowly in the cholestatic type than in the nonregenerative type after postoperative complications occurred.
  
  
  CONCLUSIONS
  Liver failure after excessive hepatectomy is of two types: cholestatic, mainly induced by postoperative infection, and nonregenerative, mainly induced by severe ischemia reperfusion injury.
authors: Second Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan. a820317d@muse.ocn.ne.jp
authors: Kazuhisa
authors: K
authors: Takeda
authors: Shinji
authors: S
authors: Togo
authors: Osamu
authors: O
authors: Kunihiro
authors: Yoshiro
authors: Y
authors: Fujii
authors: Haruki
authors: H
authors: Kurosawa
authors: Kuniya
authors: K
authors: Tanaka
authors: Itaru
authors: I
authors: Endo
authors: Atsushi
authors: A
authors: Takimoto
authors: Hitoshi
authors: H
authors: Sekido
authors: Masamichi
authors: M
authors: Hara
authors: Hiroshi
authors: H
authors: Shimada
mesh_terms: D000368:Aged; D017209:Apoptosis; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D022781:Hepatocytes / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis