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

INTRODUCTION AND AIM: It is widely accepted that during liver resections parenchymal ischemia is induced by vascular clamping and assessed on days 1 and 2 by the postoperative increase of serum transaminase level (ALT). This prospective study aimed to identify early changes in ALT level during resection. PATIENTS AND METHODS: From June 2003, 52 patients (aged 53±14 years) with an elective right hepatectomy, including 42 with intermittent clamping for a mean duration of 37 min (range 15–64), were included. Blood samples were collected during operation (before incision, before liver transection and before abdominal closure) and postoperatively, on days 1, 2, 5 and 7. RESULTS: During operation mean ALT level was 30±10 before incision; 144±116 before transection and 273±187 before abdominal closure. ALT level before abdominal closure was not statistically different in the groups with or without clamping (273±187 vs 275±198). Postoperative mean ALT level was 318±140 on day 1 and 249±137 on day 2 without significant difference according to the presence or not of clamping (326±148 vs 286±100 on day 1 and 258±148 vs 215±69). The mean ALT level before abdominal closure reflected the mean ALT level on day 1 (273±187 vs 318±140). CONCLUSION: During liver resection, the ALT level started to increase early, before parenchymal transection and was not affected by the presence of clamping. The peak of ALT level, which can be anticipated at the end of the procedure, seems to be related to factors other than ischemia-reperfusion injury