title: New paradigms in post-hepatectomy liver failure.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre Hépatobiliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris XI, Paris, France. nicolas.golse@wanadoo.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Golse
authors.forename: Petru O
authors.initials: PO
authors.lastname: Bucur
authors.forename: René
authors.initials: R
authors.lastname: Adam
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Antonio
authors.initials: A
authors.lastname: Sa Cunha
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
mesh_terms: D042783:Endothelial Cells / Q000502:physiology; D006498:Hepatectomy / Q000009:adverse effects*; D022781:Hepatocytes / Q000502:physiology; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000502:physiology* / Q000503:physiopathology; D017093:Liver Failure / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy; D009929:Organ Size; D012038:Regeneration; D012307:Risk Factors