ID: 342 (Conflict of Interest: K)

Messung der Makrohämodynamik in der Leber als prädiktive Parameter für Aszites und Leberversagen nach Leberresektion: Eine prospektive Studie

A.Bogner1, C.Reißfelder2, F.Striebel3, M. W.Büchler3, M.Rahbari1, J.Weitz2, N. N.Rahbari1
1Universitätsklinikum Dresden, Dresden
2Universitätsklinikum Carl Gustav Carus Dresden, Dresden
3Universitätsklinikum Heidelberg, Heidelberg


Large-scale ascites and posthepatectomy liver failure (PHLF) remain clinical challenges in the postoperative period after partial hepatectomy. The aim of this study was to assess hepatic macrohemodynamic changes, in particular a possible hepatic arterial buffer response, after hepatic resection and their association with ascites and PHLF.

Material und Methoden

The study was registered at ClinicalTrials.gov, number NCT01073345. One hundred patients were enrolled in a prospective study between February 2010 and October 2011. Portal vein pressure (PVP; mmHg), portal vein flow (PVF; ml/min) and hepatic artery flow (HAF; ml/min) were assessed directly before mobilization of the liver and 15 minutes after completion of parenchymal transection to allow liver macrohemodynamics to reach an equilibrium. Risk factors for ascites and PHLF were analyzed using Fisher’s exact, t-test or Wilcoxon rank sum test for univariate and logistic regression models for multivariate analyses. For hepatic macrohemodynamics preoperative and postoperative values were evaluated in these analyses as well as their intraoperative kinetics (i.e. Δ).


A major hepatectomy (i.e. more than 2 segments) was performed in 67% of patients and 8 patients underwent preoperative portal vein embolization (PVE). PHLF occurred in 12% of patients. Minor resections had little effects on hepatic macrohemodynamics. Major liver resection increased PVP by 26.9% (P = 0.001), markedly decreased HAF by 40.7% (P < 0.001) and slightly decreased PVF by 13.4% (P = 0.011). There were no significant changes of hepatic macrohemodynamics in patients with preoperative PVE. Further analyses revealed the extent of resection of being associated with ΔPVP (P = 0.001), post-resection HAF (P = 0.002) and ΔHAF (P = 0.002), whereas grade 3/4 fibrosis and platelets were associated with PVP before (P = 0.006; P = 0.001) and after (P = 0.057; P = 0.044) resection. On multivariate analysis, post-resection PVP (P = 0.036) was associated with large-scale ascites. Post-resection PVP (P = 0.015) and the extent of HAF decrease (P = 0.038) were associated independently with PHLF on multivariate analysis.


The present study for the first time demonstrates a hepatic arterial buffer response in patients undergoing hepatic resection. The changes of hepatic macrohemodynamics and their association with outcome suggest novel approaches for the prevention and treatment of large-scale ascites and liver failure after partial hepatectomy.