title: Deficiency in thrombopoietin induction after liver surgery is associated with postoperative liver dysfunction.
abstract: OBJECTIVE
  Thrombopoietin (TPO) has been implicated in the process of liver regeneration and was found to correlate with hepatic function in patients with liver disease. With this investigation we aimed to determine if perioperative TPO levels were associated with postoperative outcome in patients undergoing liver resection.
  
  
  METHODS
  Perioperative TPO was analyzed prior to liver resection as well as on the first and fifth postoperative day in 46 colorectal cancer patients with liver metastasis (mCRC) as well as 23 hepatocellular carcinoma patients (HCC). Serum markers of liver function within the first postoperative week were used to define liver dysfunction.
  
  
  RESULTS
  While circulating TPO levels significantly increased one day after liver resection in patients without liver cirrhosis (mCRC) (P < 0.001), patients with underlying liver disease (HCC) failed to significantly induce TPO postoperatively. Accordingly, HCC patients had significantly lower TPO levels on POD1 and 5. Similarly, patients with major resections failed to increase circulating TPO levels. Perioperative dynamics of TPO were found to specifically predict liver dysfunction (AUC: 0.893, P < 0.001) after hepatectomy and remained an independent predictor upon multivariate analysis.
  
  
  CONCLUSIONS
  We here demonstrate that perioperative TPO dynamics are associated with postoperative LD. Postoperative TPO levels were found to be lowest in high-risk patients (HCC patients undergoing major resection) but showed an independent predictive value. Thus, a dampened TPO increase after liver resection reflects a poor capacity for hepatic recovery and may help to identify patients who require close monitoring or intervention for potential complications.
authors.affiliation: Department of Surgery, Medical University of Vienna, General Hospital, Vienna, Austria.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Haegele
authors.affiliation: Department of Surgery, Medical University of Vienna, General Hospital, Vienna, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Offensperger
authors.affiliation: Department of Surgery, Medical University of Vienna, General Hospital, Vienna, Austria.
authors.forename: David
authors.initials: D
authors.lastname: Pereyra
authors.affiliation: Department of Surgery, Medical University of Vienna, General Hospital, Vienna, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lahner
authors.affiliation: Institute of Physiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Alice
authors.initials: A
authors.lastname: Assinger
authors.affiliation: Department of Anesthesiology, Medical University of Vienna, General Hospital, Vienna, Austria.
authors.forename: Edith
authors.initials: E
authors.lastname: Fleischmann
authors.affiliation: Department of Internal Medicine, Brothers of Charity Hospital, Vienna, Austria.
authors.forename: Birgit
authors.initials: B
authors.lastname: Gruenberger
authors.affiliation: Department of Surgery, Medical University of Vienna, General Hospital, Vienna, Austria; Department of Surgery I, Rudolf Foundation Clinic, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gruenberger
authors.affiliation: Department of Surgery, Medical University of Vienna, General Hospital, Vienna, Austria.
authors.forename: Christine
authors.initials: C
authors.lastname: Brostjan
authors.affiliation: Department of Surgery, Medical University of Vienna, General Hospital, Vienna, Austria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Starlinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000601:surgery; D015179:Colorectal Neoplasms / Q000097:blood / Q000601:surgery; D005260:Female; D006801:Humans; D008099:Liver / Q000601:surgery*; D017093:Liver Failure / Q000097:blood* / Q000209:etiology; D008113:Liver Neoplasms / Q000097:blood / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011183:Postoperative Complications / Q000097:blood*; D013926:Thrombopoietin
chemical_list: D013926:Thrombopoietin