Your browser doesn't support javascript.
loading
Early Postoperative Serum Phosphate Drop Predicts Sufficient Hypertrophy After Liver Surgery.
Kambakamba, Patryk; Schneider, Marcel A; Linecker, Michael; Kirimker, Elvan Onur; Moeckli, Beat; Graf, Rolf; Reiner, Cäcilia S; Nguyen-Kim, Thi Dan Linh; Kologlu, Meltem; Karayalcin, Kaan; Clavien, Pierre-Alain; Balci, Deniz; Petrowsky, Henrik.
Afiliación
  • Kambakamba P; Department of Surgery and Transplantation, University Hospital Zürich, Zürich, Switzerland.
  • Schneider MA; Hepatobiliary Group, St. Vincents's University Hospital, Dublin, Ireland.
  • Linecker M; Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland.
  • Kirimker EO; Department of Surgery and Transplantation, University Hospital Zürich, Zürich, Switzerland.
  • Moeckli B; Department of Surgery and Transplantation, University Hospital Zürich, Zürich, Switzerland.
  • Graf R; Department of Surgery and Transplantation, University Hospital Schleswig Holstein, Kiel, Germany.
  • Reiner CS; Department of Surgery and Transplantation, Ankara University School of Medicine, Ankara, Turkey.
  • Nguyen-Kim TDL; Department of Surgery and Transplantation, University Hospital Zürich, Zürich, Switzerland.
  • Kologlu M; Department of Surgery and Transplantation, University Hospital Zürich, Zürich, Switzerland.
  • Karayalcin K; Diagnostic and Interventional Radiology, University Hospital Zürich, Zürich, Switzerland.
  • Clavien PA; Diagnostic and Interventional Radiology, University Hospital Zürich, Zürich, Switzerland.
  • Balci D; Department of Surgery and Transplantation, Ankara University School of Medicine, Ankara, Turkey.
  • Petrowsky H; Department of Surgery and Transplantation, Ankara University School of Medicine, Ankara, Turkey.
Ann Surg ; 278(5): 763-771, 2023 11 01.
Article en En | MEDLINE | ID: mdl-37465990
OBJECTIVE: The aim of this study was to assess the impact of postoperative hypophosphatemia on liver regeneration after major liver surgery in the scenario of Associating Liver Partition with Portal vein ligation for Staged hepatectomy (ALPPS) and living liver donation (LLD). BACKGROUND: Hypophosphatemia has been described to reflect the metabolic demands of regenerating hepatocytes. Both ALPPS and LLD are characterized by an exceptionally strong liver regeneration and may be of particular interest in the context of posthepatectomy hypophosphatemia. METHODS: Serum phosphate changes within the first 7 postoperative days after ALPPS (n=61) and LLD (n=54) were prospectively assessed and correlated with standardized volumetry after 1 week. In a translational approach, postoperative phosphate changes were investigated in mice and in vitro . RESULTS: After ALPPS stage 1 and LLD, serum phosphate levels significantly dropped from a preoperative median of 1.08 mmol/L [interquartile range (IQR) 0.92-1.23] and 1.07 mmol/L (IQR 0.91-1.21) to a postoperative median nadir of 0.68 and 0.52 mmol/L, respectively. A pronounced phosphate drop correlated well with increased liver hypertrophy ( P <0.001). Patients with a low drop of phosphate showed a higher incidence of posthepatectomy liver failure after ALPPS (7% vs 31%, P =0.041). Like in humans, phosphate drop correlated significantly with degree of hypertrophy in murine ALPPS and hepatectomy models ( P <0.001). Blocking phosphate transporter (Slc20a1) inhibited cellular phosphate uptake and hepatocyte proliferation in vitro. CONCLUSION: Phosphate drop after hepatectomy is a direct surrogate marker for liver hypertrophy. Perioperative implementation of serum phosphate analysis has the potential to detect patients with insufficient regenerative capacity at an early stage.
Asunto(s)
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hipofosfatemia / Neoplasias Hepáticas Tipo de estudio: Prognostic_studies / Risk_factors_studies Límite: Animals / Humans Idioma: En Revista: Ann Surg Año: 2023 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hipofosfatemia / Neoplasias Hepáticas Tipo de estudio: Prognostic_studies / Risk_factors_studies Límite: Animals / Humans Idioma: En Revista: Ann Surg Año: 2023 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos