Serum levels of endothelin-1 after liver resection as an early predictor of postoperative liver failure. A prospective study.
OBJECTIVE
Besides the residual liver volume, damage of the microcirculation secondary to increased portal blood flow is a main determinant of postoperative liver failure (PLF). Endothelin-1 (ET-1), produced by sinusoidal endothelial cells, plays a key role in the regulation of hepatic microcirculation. The aim of this study was to determine whether ET-1 levels has any prognostic utility in predicting PLF.


METHODS
Patients undergoing liver resection for primary or secondary liver tumors at San Raffaele Hospital, Milan, were prospectively enrolled in the study. Serial postoperative serum ET-1 levels in patients undergoing liver resections were correlated with indices of inflammatory response, liver failure and death.


RESULTS
A total of 144 patients were included. ET-1 levels in patients who underwent major or extended liver resection were significantly higher than in patients who had a minor resection on postoperative day (POD) 1 (P = 0.003), POD 2 (P = 0.0001) and POD 5 (P = 0.0001). Eight patients developed PLF and ET-1 was significantly higher compared with patients without PLF on POD 2 (P = 0.002) and POD5 (P = 0.006). Serum ET-1 concentration on POD 2 was an independent predictor of PLF in multivariate analysis.


CONCLUSIONS
ET-1 is as an early index of PLF and provides a rationale for therapeutic manipulation, with many potential clinical implications to prevent PLF onset and reduce its severity.
Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.
Francesca
F
Ratti
Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.
Carlo
C
Pulitanò
Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.
Marco
M
Catena
Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.
Michele
M
Paganelli
Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.
Luca
L
Aldrighetti
endothelin-1; hyperperfusion; liver damage; liver failure; liver resection