INTRA-OPERATIVE LIVER INJURY IS NOT ONLY RELATED TO VASCULAR CLAMPING

BACKGROUND/AIMS: Postoperative increase of serum transaminase levels is accepted as the most accurate marker of hepatocyte injury after hepatectomy. Vascular clamping is considered as the main factor of liver injury. However, several studies failed to establish a correlation between the postoperative serum transaminase levels and the type and duration of vascular clamping. Therefore, we prospectively evaluated sequential changes of serum transaminase levels during and after liver resection. METHODS: Between June 2003 and September 2003, 40 patients, aged 53±14 years, who underwent elective, exclusive hepatic resection on normal liver, were included in a prospective study. Major resection (>3 segments) was present in 33 (82%). Liver transection was performed in 20 patients under intermittent clamping for a mean duration of 37 min (range 15–64 min); the other 20 cases had no vascular occlusion. All patients underwent serial blood samples assessing transaminase levels (ALT) during surgical procedure, respectively before incision, before liver transection and before abdominal closure and postoperatively, respectively on days 1, 2, 5 and 7. RESULTS: The overall intraoperative measurement of ALT was respectively 31±11 before incision; 134±62 before transection and 222±117 before abdominal closure. ALT serum levels before abdominal closure were not statistically different between the two groups with and without clamping (212±101 vs 233±133). Postoperative ALT serum levels were similar between the two groups, with and without clamping, on days 1, 2, 5 and 7; respectively 289±99 vs 341±246; 227±111 vs 314±254; 127±62 vs 157±130; 73±43 vs 109±91. CONCLUSIONS: Our results show that, during liver resection, serum transaminase levels start to increase early, before the parenchymal transection and that the peak on day 1 was not related to the presence of clamping. These results suggest that other factors of hepatocyte injury, such as manipulation or compression of the parenchyma, should be taken in account