Analysis of hepatic reserve function after extended hepatectomy and treatment of acute liver failure induced by extended hepatectomy

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Extended hepatectomy for advanced biliary cancer may result in acute liver failure even if in patients with normal liver function. Preoperative and postoperative evaluation of hepatic reserve function especially in patients with liver cirrhosis or obstructive jaundice, to prevent postoperative liver failure, is very important.1.The changes of mRNA expression of the organic anion transporters (mrp2, mrp3, bsep, oatp and ntcp) depending on the duration of bile duct ligation have been examined in rats. Blood and liver tisues were obtained during the period from 3 to 28 days after the ligation. The excretion transporters, the mRNA levels of mrp2 and bsep decreased, while those of mrp3 increased from 3 days until 28 days after the ligation. The uptake transporters, ntcp and oatp decreased until 28 days after the ligation. After 7 days ligation of bile duct, external and internal biliary drainage were performed. The expression of mrp2 mRNA levels increased, while those of mrp3 decreased. The … More se changes of mrp2 and mrp3 mRNA expressions were significantly stronger in the internal biliary drainage than the external drainage. These suggest that the internal biliary drainage is useful for hepatic function reserve. We are now examining the expression of these protein levels.2.We evaluated the differences in hepatic reserve function and parameters to predict the liver failure in the early stage after extended hepatectomy in rats. The survival rates of 48 hours after hepatectomy were 50% in 90% hepatectomy and 100% in 70% hepatectomy. 90% hepatectomy is a model for acute liver failure. We determined the bile flow, biliary bile acid excretion and the mRNA levels of organic anion transporters (mrp2, mrp3 and bsep) after 70% or 90% hepatectomy in rats. The bile flow and bile acid excretion both decreased significantly after the 90% hepatectomy. Biliary bile acid excretion and the expression of mrp2 decreased, while the expressions of mrp3 and bsep increased after 90% hepatectomy. In contrast, the expression of mrp2 increased, while the expressions of mrp3 and bsep decreased after 70% hepatectomy. The expressions of mrp2 and mrp3 were differently regulated after 70% and 90% hepatectomy. We suspected that expressions of mrp2 and mrp3 and biliary bile acid excretion and bile flow might be able to predict the liver failure after extended hepatectomy. Less