Posthepatectomy hepatic failure(PHF) is a potentially lethal complication. PHF can develop when the remaining liver is too small after extensive hepatectomy. There have been very limited treatment options proven to be effective in this clinical setting. Small-for-size syndrome(SFSS) after partial liver transplantation has a similar pathophysiologic mechanism. Several invasive procedures such as splenic artery ligation/embolization, portocaval shunt and splenectomy have been used to prevent or manage these complications with limited success. Occasional serious complications from such procedures also have been reported. We aimed to study about the possible role of portal pressure modulating drugs for the management of PHF or SFSS. An experiment was performed using 90% partial hepatectomy model in rats. Rats were divided into 5 groups, sham operation(n=6), control(n=20), propranolol(n=20), somatostatin(n=20) and terlipressin group(n=20). Somatostatin and terlipressin were injected 5 minutes after operation and propranolol was given orally dissolved in water for 3 days before operation. We measured 7-day survival rate, portal pressure changes, biochemical analysis, histologic differences and alterations in gene expression(endothelin-1, endothelial nitric oxide synthase, transforming growth factor-Β1 receptor, hepatocyte growth factor) by real-time RT-PCR in each group. Mean survival time was 42.1 hours in control group, 71.9 hours in propranolol group(p=0.189), 52.9 hours in somatostatin group(p=0.817) and 128.9 hours in terlipressin group(p<0.01). Significant decrease in portal pressure of 30, 60 minutes and 24 hours after operation was observed in all three drug groups. AST, ALT and total bilirubin didn’t show differences at 1 and 6 hours after operation but significant decrease at 24 hours after operation in all drug groups. Histologic scoring was significantly lowered and Ki-67 staining cells were increased after 24 hours in all drug groups but there were no differences in TUNEL statin positivity comparing with control group. Expression of transforming growth factor-Β1 receptor was significantly decreased(p=0.045) and that of endothelin-1 was also decreased with borderline significance(p=0.068) in somatostatin group. In conclusion, potential role of portal pressure modulating drugs in prevention and treatment of PHF and SFSS could be observed.

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