Analysis of the role of hepatic remodeling and signal of hepatic regeneration after hepatic ischemia/reperfusion injury in obstructive jaundice

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Cholestasis of the liver is known to be an important risk factor for surgical morbidity and mortality after major hepatectomy. However, the mechanism of liver injury in cholestatic liver is not fully understood. Our data suggests that hepatic stellate cell activation and increased endothelin-1 production play a crucial role in hepatic ischemia/reperfusion injury in cholestatic liver. To identify predictive factors for postoperative liver regeneration after major hepatectoy, clinical factors and liver volumetric changes determined by CT volumetry and CT attenuation values (CT-AVs) were compared in patients with and without postoperative hepatic failure. Postoperative lower CT-AV was the only independent risk factor of postoperative hepatic failure. Preoperative portal vein embolization (PVE) is an effective means of creating hypertrophy of future remaining liver, which leads to safety of extensive hepatectomy for hepatic malignancies. Plasma VEGF levels were increased markedly after PVE and were maximal after 7 days of PVE. Measurement of plasma VEGF levels after PVE may be a predictive factor of potential liver regeneration and may provide useful information to decide on the schedule of subsequent hepatectomy.