Background:For its better differentiated hepatocyte phenotype,C3A cell line has been utilized in bioar-tificial liver system.However,up to now,there are only a few of studies working at the metabolic alter-nations of ...Background:For its better differentiated hepatocyte phenotype,C3A cell line has been utilized in bioar-tificial liver system.However,up to now,there are only a few of studies working at the metabolic alter-nations of C3A cells under the culture conditions with liver failure plasma,which mainly focus on car-bohydrate metabolism,total protein synthesis and ureagenesis.In this study,we investigated the effects of acute liver failure plasma on the growth and biological functions of C3A cells,especially on CYP450 enzymes.Methods:C3A cells were treated with fresh DMEM medium containing 10%FBS,fresh DMEM medium containing 10%normal plasma and acute liver failure plasma,respectively.After incubation,the C3A cells were assessed for cell viabilities,lactate dehydrogenase leakage,gene transcription,protein levels,albu-min secretion,ammonia metabolism and CYP450 enzyme activities.Results:Cell viabilities decreased 15%,and lactate dehydrogenase leakage had 1.3-fold elevation in acute liver failure plasma group.Gene transcription exhibited up-regulation,down-regulation or stability for different hepatic genes.In contrast,protein expression levels for several CYP450 enzymes kept constant,while the CYP450 enzyme activities decreased or remained stable.Albumin secretion reduced about 48%,and ammonia accumulation increased approximately 41%.Conclusions:C3A cells cultured with acute liver failure plasma showed mild inhibition of cell viabilities,reduction of albumin secretion,and increase of ammonia accumulation.Furthermore,CYP450 enzymes demonstrated various alterations on gene transcription,protein expression and enzyme activities.展开更多
Purpose: To evaluate posthepatectomy liver failure (PHLF) using gadoxetic acid-enhanced magnetic resonance imaging (MRI) with a measure of relative liver enhancement (RLE) on hepatobiliary phase images, thereby facili...Purpose: To evaluate posthepatectomy liver failure (PHLF) using gadoxetic acid-enhanced magnetic resonance imaging (MRI) with a measure of relative liver enhancement (RLE) on hepatobiliary phase images, thereby facilitating safe liver resection. Methods: Twenty patients in Child-Pugh class A underwent tumor excision surgery and indocyanine green (ICG) clearance of future remnant liver (FRL) (ICG-Krem) values were >0.05. PHLF was evaluated using the grading system of the International Study Group of Liver Surgery (ISGLS). The RLE value was defined as the signal gain percentage between the precontrast and hepatocellular images. In the whole liver and FRL, theRLE value measured the tumor-free liver parenchyma in RLE images. We examined the correlation between indocyanine green clearance (ICG-K) and MRI-based liver function in the whole liver. Preoperative PHLF evaluation was predicted using remnant hepatocellular uptake index (rHUI), remnant RLE (rRLE), coefficient variation of Rrle [Cv(rRLE)], and ICG-Krem corrected by heterogeneous liver function(HLF-ICG-Krem). Results: HLF-ICG-Krem and rRLE values correlated with INRs after postoperative day five (r = -0.55 and 0.46, p = 0.01 and 0.04, respectively). Furthermore, HLF-ICG-Krem values ≤0.05 detected two patients with higher INRs after postoperative day five. On the other hand, neither rHUI nor Cv(rRLE) was correlated with INRs after postoperative day five (r = 0.28, and -0.03, respectively;p >0.05 for both). HLF-ICG-Krem was significantly lower with PHLF than without PHLF (p = 0.005). Conclusion: HLF-ICG-Krem is useful for evaluating PHLF more correctly.展开更多
Post-hepatectomy liver failure(PHLF) is a leading cause of morbidity and mortality following major liver resection. The development of PHLF is dependent on the volume of the remaining liver tissue and hepatocyte funct...Post-hepatectomy liver failure(PHLF) is a leading cause of morbidity and mortality following major liver resection. The development of PHLF is dependent on the volume of the remaining liver tissue and hepatocyte function. Without effective pre-operative assessment, patients with undiagnosed liver disease could be at increased risk of PHLF. We report a case of a 60-year-old male patient with PHLF secondary to undiagnosed alpha-1-antitrypsin deficiency(AATD) following major liver resection. He initially presented with acute large bowel obstruction secondary to a colorectal adenocarcinoma, which had metastasized to the liver. There was no significant past medical history apart from mild chronic obstructive pulmonary disease. After colonic surgery and liver directed neo-adjuvant chemotherapy, he underwent a laparoscopic partially extended right hepatectomy and radio-frequency ablation. Post-operatively he developed PHLF. The cause of PHLF remained unknown, prompting reanalysis of the histology, which showed evidence of AATD. He subsequently developed progressive liver dysfunction, portal hypertension, and eventually an extensive parastomal bleed, which led to his death; this was ultimately due to a combination of AATD and chemotherapy. This case highlights that formal testing for AATD in all patients with a known history of chronic obstructive pulmonary disease, heavy smoking, or strong family history could help prevent the development of PHLF in patients undergoing major liver resection.展开更多
BACKGROUND Liver resection is an effective treatment for benign and malignant liver tumors.However,a method for preoperative evaluation of hepatic reserve has not yet been established.Previously reported assessments o...BACKGROUND Liver resection is an effective treatment for benign and malignant liver tumors.However,a method for preoperative evaluation of hepatic reserve has not yet been established.Previously reported assessments of preoperative hepatic reserve focused only on liver failure in the early postoperative period and did not consider the long-term recovery of hepatic reserve.When determining eligibility for hepatectomy,the underlying pathophysiology needs to be considered to determine if the functional hepatic reserve can withstand both surgery and any postoperative therapy.AIM To identify pre-hepatectomy factors associated with both early postoperative liver failure and long-term postoperative liver function recovery.METHODS This study was a retrospective cohort study.We retrospectively investigated 215 patients who underwent hepatectomy at our hospital between May 2013 and December 2016.Early post-hepatectomy liver failure(PHLF)was defined using the International Study Group of Liver Surgery’s definition of PHLF.Long-term postoperative recovery of liver function was defined as the time taken for serum total bilirubin and albumin levels to return to levels of<2 mg/dL and>2.8 g/dL,respectively,and the time taken for Child-Pugh score to return to Child-Pugh class A.RESULTS Preoperative type IV collagen 7S was identified as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function.Further analysis revealed that the time taken for the recovery of Child-Pugh scores and serum total bilirubin and albumin levels was significantly shorter in patients with type IV collagen 7S≤6 ng/mL than in those with type IV collagen 7S>6 ng/mL.In additional analyses,similar results were observed in patients without chronic viral hepatitis associated with fibrosis.CONCLUSION Preoperative type IV collagen 7S is a preoperative predictor of PHLF and longterm postoperative liver function recovery.It can also be used in patients without chronic hepatitis virus.展开更多
The liver is often involved in systemic infections,resulting in various types of abnormal liver function test results.In particular,hyperbilirubinemia in the range of 2-10 mg/dL is often seen in patients with sepsis,a...The liver is often involved in systemic infections,resulting in various types of abnormal liver function test results.In particular,hyperbilirubinemia in the range of 2-10 mg/dL is often seen in patients with sepsis,and several mechanisms for this phenomenon have been proposed.In this review,we summarize how the liver is involved in various systemic infections that are not considered to be primarily hepatotropic.In most patients with systemic infections,treatment for the invading microbes is enough to normalize the liver function tests.However,some patients may show severe liver injury or fulminant hepatic failure,requiring intensive treatment of the liver.展开更多
Background and Aims:Programmed cell death-1(PD-1)plays an important role in downregulating T lymphocytes but the mechanisms are still poorly understood.This study aimed to explore the role of PD-1 in CD8^(+)T lymphocy...Background and Aims:Programmed cell death-1(PD-1)plays an important role in downregulating T lymphocytes but the mechanisms are still poorly understood.This study aimed to explore the role of PD-1 in CD8^(+)T lymphocyte dysfunction in hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF).Methods:Thirty patients with HBV-ACLF and 30 healthy controls(HCs)were recruited.The differences in the numbers and functions of CD8^(+)T lymphocytes,PD-1 and glucose transporter-1(Glut1)expression from the peripheral blood of patients with HBV-ACLF and HCs were analyzed.In vitro,the CD8^(+)T lymphocytes from HCs were cultured(HC group)and the CD8^(+)T lymphocytes from ACLF patients were cultured with PD-L1-IgG(ACLF+PD-1 group)or IgG(ACLF group).The numbers and functions of CD8^(+)T lymphocytes,PD-1 expression,glycogen uptake capacity,and Glut1,hexokinase-2(HK2),and pyruvate kinase(PKM2)expression were analyzed among the HC group,ACLF group and ACLF+PD-1group.Results:The absolute numbers of CD8^(+)T lymphocytes in the peripheral blood from patients with HBVACLF were lower than in the HCs(p<0.001).The expression of PD-1 in peripheral blood CD8^(+)T lymphocytes was lower in HCs than in patients with HBV-ACLF(p=0.021).Compared with HCs,PD-1 expression was increased(p=0.021)and Glut1 expression was decreased(p=0.016)in CD8^(+)T lymphocytes from the HBV-ACLF group.In vitro,glycogen uptake and functions of ACLF CD8^(+)T lymphocytes were significantly lower than that in HCs(p=0.017;all p<0.001).When PD-1/PD-L1 was activated,the glycogen uptake rate and expression levels of Glut1,HK2,and PKM2 showed a decreasing trend(ACLF+PD-1 group compared to ACLF group,all p<0.05).The functions of CD8^(+)T lymphocytes in the ACLF+PD-1 group[using biomarkers of Ki67,CD69,IL-2,interferon-gamma,and tumor necrosis factor-alpha-were lower than in the ACLF group(all p<0.05).Conclusions:CD8^(+)T lymphocyte dysfunction is observed in patients with HBV-ACLF.PD-1-induced T lymphocyte dysfunction might involve glycolysis inhibition.展开更多
Liver transplantation represents a fundamental therapeutic solution to end-stage liver disease. The need for liver allografts has extended the set of criteria for organ acceptability, increasing the risk of adverse ou...Liver transplantation represents a fundamental therapeutic solution to end-stage liver disease. The need for liver allografts has extended the set of criteria for organ acceptability, increasing the risk of adverse outcomes. Little is known about the early postoperative parameters that can be used as valid predictive indices for early graft function, retransplantation or surgical reintervention, secondary complications, long intensive care unit stay or death. In this review, we present state-of-the-art knowledge regarding the early posttransplantation tests and scores that can be applied during the first postoperative week to predict liver allograft function and patient outcome, thereby guiding the therapeutic and surgical decisions of the medical staff. Post-transplant clinical and biochemical assessment of patients through laboratory tests(platelet count, transaminase and bilirubin levels, INR, factor V, lactates, and Insulin Growth Factor 1) and scores(model for end-stage liver disease, acute physiology and chronic health evaluation, sequential organ failure assessment and model of early allograft function have been reported to have good performance, but they only allow late evaluation of patient status and graft function, requiring days to be quantified. The indocyanine green plasma disappearance rate has long been used as a liver function assessment technique and has produced interesting, although not univocal, results when performed between the 1th and the 5th day after transplantation. The liver maximal function capacity test is a promising method of metabolic liver activity assessment, but its use is limited by economic cost and extrahepatic factors. To date, a consensual definition of early allograft dysfunction and the integration and validation of the above-mentioned techniques, through the development of numerically consistent multicentric prospective randomised trials, are necessary. The medical and surgical management of transplanted patients could be greatly improved by using clinically reliable tools to predict early graft function.展开更多
BACKGROUND Liver resection has become safer as it has become less invasive.However,the minimum residual liver volume(RLV)required to maintain homeostasis is unclear.Furthermore,the formulae used to calculate standard ...BACKGROUND Liver resection has become safer as it has become less invasive.However,the minimum residual liver volume(RLV)required to maintain homeostasis is unclear.Furthermore,the formulae used to calculate standard liver volume(SLV)are complex.AIM To review previously reported SLV formulae and the methods used to evaluate the minimum RLV,and explore the association between liver volume and mortality.METHODS A systematic review of Medline,PubMed,and grey literature was performed.References in the retrieved articles were cross-checked manually to obtain further studies.The last search was conducted on January 20,2019.We developed an SLV formula using data for 86 consecutive patients who underwent hepatectomy at our institution between July 2009 and August 2011.RESULTS Linear regression analysis revealed the following formula:SLV(mL)=822.7×body surface area(BSA)?183.2(R2=0.419 and R=0.644,P<0.001).We retrieved 25 studies relating to SLV formulae and 12 studies about the RLV required for safe liver resection.Although the previously reported formulae included various coefficient and constant values,a simplified version of the SLV,the common SLV(cSLV),can be calculated as follows:cSLV(mL)=710 or 770×BSA.The minimum RLV for normal and damaged livers ranged from 20%-40%and 30%-50%,respectively.The Sapporo score indicated that the minimum RLV ranges from 35%-95%depending on liver function.CONCLUSION We reviewed SLV formulae and the minimum RLV required for safe liver resection.The Sapporo score is the only liver function-based method for determining the minimum RLV.展开更多
基金supported by grants from the Independent Project Fund of the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,the National Key Research and Development Program of China(2016YFC1101304/3)the Key Program of the National Natural Science Foundation of China(81330011)Science Fund for Creative Research Groups of the National Natural Science Foundation of China(81721091).
文摘Background:For its better differentiated hepatocyte phenotype,C3A cell line has been utilized in bioar-tificial liver system.However,up to now,there are only a few of studies working at the metabolic alter-nations of C3A cells under the culture conditions with liver failure plasma,which mainly focus on car-bohydrate metabolism,total protein synthesis and ureagenesis.In this study,we investigated the effects of acute liver failure plasma on the growth and biological functions of C3A cells,especially on CYP450 enzymes.Methods:C3A cells were treated with fresh DMEM medium containing 10%FBS,fresh DMEM medium containing 10%normal plasma and acute liver failure plasma,respectively.After incubation,the C3A cells were assessed for cell viabilities,lactate dehydrogenase leakage,gene transcription,protein levels,albu-min secretion,ammonia metabolism and CYP450 enzyme activities.Results:Cell viabilities decreased 15%,and lactate dehydrogenase leakage had 1.3-fold elevation in acute liver failure plasma group.Gene transcription exhibited up-regulation,down-regulation or stability for different hepatic genes.In contrast,protein expression levels for several CYP450 enzymes kept constant,while the CYP450 enzyme activities decreased or remained stable.Albumin secretion reduced about 48%,and ammonia accumulation increased approximately 41%.Conclusions:C3A cells cultured with acute liver failure plasma showed mild inhibition of cell viabilities,reduction of albumin secretion,and increase of ammonia accumulation.Furthermore,CYP450 enzymes demonstrated various alterations on gene transcription,protein expression and enzyme activities.
文摘Purpose: To evaluate posthepatectomy liver failure (PHLF) using gadoxetic acid-enhanced magnetic resonance imaging (MRI) with a measure of relative liver enhancement (RLE) on hepatobiliary phase images, thereby facilitating safe liver resection. Methods: Twenty patients in Child-Pugh class A underwent tumor excision surgery and indocyanine green (ICG) clearance of future remnant liver (FRL) (ICG-Krem) values were >0.05. PHLF was evaluated using the grading system of the International Study Group of Liver Surgery (ISGLS). The RLE value was defined as the signal gain percentage between the precontrast and hepatocellular images. In the whole liver and FRL, theRLE value measured the tumor-free liver parenchyma in RLE images. We examined the correlation between indocyanine green clearance (ICG-K) and MRI-based liver function in the whole liver. Preoperative PHLF evaluation was predicted using remnant hepatocellular uptake index (rHUI), remnant RLE (rRLE), coefficient variation of Rrle [Cv(rRLE)], and ICG-Krem corrected by heterogeneous liver function(HLF-ICG-Krem). Results: HLF-ICG-Krem and rRLE values correlated with INRs after postoperative day five (r = -0.55 and 0.46, p = 0.01 and 0.04, respectively). Furthermore, HLF-ICG-Krem values ≤0.05 detected two patients with higher INRs after postoperative day five. On the other hand, neither rHUI nor Cv(rRLE) was correlated with INRs after postoperative day five (r = 0.28, and -0.03, respectively;p >0.05 for both). HLF-ICG-Krem was significantly lower with PHLF than without PHLF (p = 0.005). Conclusion: HLF-ICG-Krem is useful for evaluating PHLF more correctly.
文摘Post-hepatectomy liver failure(PHLF) is a leading cause of morbidity and mortality following major liver resection. The development of PHLF is dependent on the volume of the remaining liver tissue and hepatocyte function. Without effective pre-operative assessment, patients with undiagnosed liver disease could be at increased risk of PHLF. We report a case of a 60-year-old male patient with PHLF secondary to undiagnosed alpha-1-antitrypsin deficiency(AATD) following major liver resection. He initially presented with acute large bowel obstruction secondary to a colorectal adenocarcinoma, which had metastasized to the liver. There was no significant past medical history apart from mild chronic obstructive pulmonary disease. After colonic surgery and liver directed neo-adjuvant chemotherapy, he underwent a laparoscopic partially extended right hepatectomy and radio-frequency ablation. Post-operatively he developed PHLF. The cause of PHLF remained unknown, prompting reanalysis of the histology, which showed evidence of AATD. He subsequently developed progressive liver dysfunction, portal hypertension, and eventually an extensive parastomal bleed, which led to his death; this was ultimately due to a combination of AATD and chemotherapy. This case highlights that formal testing for AATD in all patients with a known history of chronic obstructive pulmonary disease, heavy smoking, or strong family history could help prevent the development of PHLF in patients undergoing major liver resection.
文摘BACKGROUND Liver resection is an effective treatment for benign and malignant liver tumors.However,a method for preoperative evaluation of hepatic reserve has not yet been established.Previously reported assessments of preoperative hepatic reserve focused only on liver failure in the early postoperative period and did not consider the long-term recovery of hepatic reserve.When determining eligibility for hepatectomy,the underlying pathophysiology needs to be considered to determine if the functional hepatic reserve can withstand both surgery and any postoperative therapy.AIM To identify pre-hepatectomy factors associated with both early postoperative liver failure and long-term postoperative liver function recovery.METHODS This study was a retrospective cohort study.We retrospectively investigated 215 patients who underwent hepatectomy at our hospital between May 2013 and December 2016.Early post-hepatectomy liver failure(PHLF)was defined using the International Study Group of Liver Surgery’s definition of PHLF.Long-term postoperative recovery of liver function was defined as the time taken for serum total bilirubin and albumin levels to return to levels of<2 mg/dL and>2.8 g/dL,respectively,and the time taken for Child-Pugh score to return to Child-Pugh class A.RESULTS Preoperative type IV collagen 7S was identified as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function.Further analysis revealed that the time taken for the recovery of Child-Pugh scores and serum total bilirubin and albumin levels was significantly shorter in patients with type IV collagen 7S≤6 ng/mL than in those with type IV collagen 7S>6 ng/mL.In additional analyses,similar results were observed in patients without chronic viral hepatitis associated with fibrosis.CONCLUSION Preoperative type IV collagen 7S is a preoperative predictor of PHLF and longterm postoperative liver function recovery.It can also be used in patients without chronic hepatitis virus.
文摘The liver is often involved in systemic infections,resulting in various types of abnormal liver function test results.In particular,hyperbilirubinemia in the range of 2-10 mg/dL is often seen in patients with sepsis,and several mechanisms for this phenomenon have been proposed.In this review,we summarize how the liver is involved in various systemic infections that are not considered to be primarily hepatotropic.In most patients with systemic infections,treatment for the invading microbes is enough to normalize the liver function tests.However,some patients may show severe liver injury or fulminant hepatic failure,requiring intensive treatment of the liver.
基金This study was funded by the National Natural Science Foundation of China(81700562)the Shanxi Outstanding Youth Fund Project(201801D211009)+2 种基金the Shanxi Province Key Program Project(201903D321125)the Shanxi Province 136 Revitalization Medical Project(General Surgery Department)International Cooperation in Key R&D Projects of Shanxi Province(No.201903D421026).
文摘Background and Aims:Programmed cell death-1(PD-1)plays an important role in downregulating T lymphocytes but the mechanisms are still poorly understood.This study aimed to explore the role of PD-1 in CD8^(+)T lymphocyte dysfunction in hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF).Methods:Thirty patients with HBV-ACLF and 30 healthy controls(HCs)were recruited.The differences in the numbers and functions of CD8^(+)T lymphocytes,PD-1 and glucose transporter-1(Glut1)expression from the peripheral blood of patients with HBV-ACLF and HCs were analyzed.In vitro,the CD8^(+)T lymphocytes from HCs were cultured(HC group)and the CD8^(+)T lymphocytes from ACLF patients were cultured with PD-L1-IgG(ACLF+PD-1 group)or IgG(ACLF group).The numbers and functions of CD8^(+)T lymphocytes,PD-1 expression,glycogen uptake capacity,and Glut1,hexokinase-2(HK2),and pyruvate kinase(PKM2)expression were analyzed among the HC group,ACLF group and ACLF+PD-1group.Results:The absolute numbers of CD8^(+)T lymphocytes in the peripheral blood from patients with HBVACLF were lower than in the HCs(p<0.001).The expression of PD-1 in peripheral blood CD8^(+)T lymphocytes was lower in HCs than in patients with HBV-ACLF(p=0.021).Compared with HCs,PD-1 expression was increased(p=0.021)and Glut1 expression was decreased(p=0.016)in CD8^(+)T lymphocytes from the HBV-ACLF group.In vitro,glycogen uptake and functions of ACLF CD8^(+)T lymphocytes were significantly lower than that in HCs(p=0.017;all p<0.001).When PD-1/PD-L1 was activated,the glycogen uptake rate and expression levels of Glut1,HK2,and PKM2 showed a decreasing trend(ACLF+PD-1 group compared to ACLF group,all p<0.05).The functions of CD8^(+)T lymphocytes in the ACLF+PD-1 group[using biomarkers of Ki67,CD69,IL-2,interferon-gamma,and tumor necrosis factor-alpha-were lower than in the ACLF group(all p<0.05).Conclusions:CD8^(+)T lymphocyte dysfunction is observed in patients with HBV-ACLF.PD-1-induced T lymphocyte dysfunction might involve glycolysis inhibition.
文摘Liver transplantation represents a fundamental therapeutic solution to end-stage liver disease. The need for liver allografts has extended the set of criteria for organ acceptability, increasing the risk of adverse outcomes. Little is known about the early postoperative parameters that can be used as valid predictive indices for early graft function, retransplantation or surgical reintervention, secondary complications, long intensive care unit stay or death. In this review, we present state-of-the-art knowledge regarding the early posttransplantation tests and scores that can be applied during the first postoperative week to predict liver allograft function and patient outcome, thereby guiding the therapeutic and surgical decisions of the medical staff. Post-transplant clinical and biochemical assessment of patients through laboratory tests(platelet count, transaminase and bilirubin levels, INR, factor V, lactates, and Insulin Growth Factor 1) and scores(model for end-stage liver disease, acute physiology and chronic health evaluation, sequential organ failure assessment and model of early allograft function have been reported to have good performance, but they only allow late evaluation of patient status and graft function, requiring days to be quantified. The indocyanine green plasma disappearance rate has long been used as a liver function assessment technique and has produced interesting, although not univocal, results when performed between the 1th and the 5th day after transplantation. The liver maximal function capacity test is a promising method of metabolic liver activity assessment, but its use is limited by economic cost and extrahepatic factors. To date, a consensual definition of early allograft dysfunction and the integration and validation of the above-mentioned techniques, through the development of numerically consistent multicentric prospective randomised trials, are necessary. The medical and surgical management of transplanted patients could be greatly improved by using clinically reliable tools to predict early graft function.
基金Supported by a Grant-in-Aid for Scientific Research from the Ministry of Education,Culture,Sports,Science,and Technology,Japan,No.23591993 to TM,and No.24791437 to MM,No17K10672to T Mizuguchi+8 种基金supported by Astellas Pharma,Inc.,No.RS2018A000763,Tokyo,JapanDaiichi Sankyo Company,No.1800461,Tokyo,JapanShionogi&Co.,No.RS2018A000439931,Osaka,JapanMerk Serono,No.MSJS20180613001,Tokyo,JapanSapporo Doto Hospital,No.30037656,Sapporo,JapanNoguchi Hospital,No.30047663,Otaru,JapanDoki-kai Tomakomai Hospital,No.30047674,Tomakomai,JapanTsuchida Hospital,No.30057704,Sapporo,JapanIkuta Hospital,No.30057704,Shiraoi,Japan was given to TM
文摘BACKGROUND Liver resection has become safer as it has become less invasive.However,the minimum residual liver volume(RLV)required to maintain homeostasis is unclear.Furthermore,the formulae used to calculate standard liver volume(SLV)are complex.AIM To review previously reported SLV formulae and the methods used to evaluate the minimum RLV,and explore the association between liver volume and mortality.METHODS A systematic review of Medline,PubMed,and grey literature was performed.References in the retrieved articles were cross-checked manually to obtain further studies.The last search was conducted on January 20,2019.We developed an SLV formula using data for 86 consecutive patients who underwent hepatectomy at our institution between July 2009 and August 2011.RESULTS Linear regression analysis revealed the following formula:SLV(mL)=822.7×body surface area(BSA)?183.2(R2=0.419 and R=0.644,P<0.001).We retrieved 25 studies relating to SLV formulae and 12 studies about the RLV required for safe liver resection.Although the previously reported formulae included various coefficient and constant values,a simplified version of the SLV,the common SLV(cSLV),can be calculated as follows:cSLV(mL)=710 or 770×BSA.The minimum RLV for normal and damaged livers ranged from 20%-40%and 30%-50%,respectively.The Sapporo score indicated that the minimum RLV ranges from 35%-95%depending on liver function.CONCLUSION We reviewed SLV formulae and the minimum RLV required for safe liver resection.The Sapporo score is the only liver function-based method for determining the minimum RLV.
