Risk factors for pulmonary complications after hepatic resection: role of intraoperative hemodynamic instability and hepatic ischemia

Abstract Background Postoperative operative pulmonary complications (PPCs) after hepatic surgery are associated with increased length of hospital stays. Intraoperative blood transfusion, extensive resection and different comorbidities have been identified. Other parameters, like time of hepatic ischemia, have neither been clinically studied, though experimental studies show that hepatic ischemia can provide lung injury. The objective of this study was to determinate the risk factors of postoperative pulmonary complications (PPCs) after hepatic resection within 7 postoperative days. Method Ninety-four patients consecutively who underwent elective hepatectomy between January and December 2013. Demographic data, pathological variables, and preoperative, intraoperative, and postoperative variables had been prospectively collected in a data base. The dependant variables studied were the occurrence of PPCs, defined before analysis of the data. Results PPCs occurred in 32 (34%) patients. A multivariate analysis allowed identifying the risk factors for PPCs. On multivariate analysis, preoperative gamma-glutamyltransferase (GGT) elevation OR =5,12 [1,85-15,69] p = 0,002, liver ischemia duration OR = 1,03 [1,01-1,06] p = 0,01 and the intraoperative use of vasopressor OR = 4,40 [1,58-13,36] p = 0,006 were independently associated with PPCs. For every 10 min added in ischemia duration, the OR of the risk of PPCs was estimated to be 1.37 (CI95% = [1.08-1.81], p = 0.01). Conclusion Three risk factors for PPCs have been identified in a population undergoing liver resection: preoperative GGT elevation, ischemia duration and the intraoperative use of vasopressor. PPCs after liver surgery could be related to lung injury induced by liver ischemia reperfusion and not solely by direct infectious process. That could explain why factors influencing directly or indirectly liver ischemia were independently associated with PPCs

Evolution of platelet functions in cirrhotic patients undergoing liver transplantation: A prospective exploration over a month.

This prospective observational study was designed to analyze platelet functions across time in 50 patients scheduled for liver transplantation (LT) secondary to decompensated cirrhosis or hepatocellular carcinoma. Platelet functions were assessed before LT (pre-LT), one week (D7) and 1 month (D28) after LT. Platelet count significantly increased from pre-LT time to day 28 as well as circulating CD34+hematopoietic stem cells. To avoid any influence of platelet count on assays, platelet function was evaluated on platelet-rich-plasma adjusted to pre-LT platelet count. Although platelet secretion potential did not differ between time-points, as evaluated by the expression of CD62P upon strong activation, platelet aggregation in response to various agonists significantly increased along time, however with no concomitant increase of circulating markers of platelet activation: platelet microvesicles, platelet-leukocyte complexes, soluble CD40L and soluble CD62P. In the multivariate analysis, hepatic function was associated with platelet count and function. A lower platelet aggregation recovery was correlated with Child C score. History of thrombosis or bleeding was associated with respective higher or lower values of platelet aggregation. This longitudinal analysis of platelet functions in LT patients showed an improvement of platelet functions along time together with platelet count increase, with no evidence of platelet hyperactivation at any time-point

Evolution of platelet functions in cirrhotic patients undergoing liver transplantation: A prospective exploration over a month - Fig 3

<p><b>Boxplots at different time points for (A) 10 μM ADP-induced platelet aggregation, (B) 1.5 mM arachidonic acid-induced platelet aggregation, (C) 20 μM TRAP-induced platelet aggregation, (D) 1 mg/mL ristocetin-induced platelet agglutination, (E) platelet microvesicles as a % of total platelet count, (F) soluble CD62P.</b> Horizontal lines show median values and the 25–75 percentiles. Pre LT: pre liver transplantation.</p

Evolution of platelet functions in cirrhotic patients undergoing liver transplantation: A prospective exploration over a month - Fig 2

<p><b>(A) Boxplots for platelet count and (B) CD34+ hematopoietic progenitor stem cells at different time points.</b> Horizontal lines show median values and the 25–75 percentiles. Pre LT: pre liver transplantation.</p

Baseline characteristics of the study population at inclusion and quality of the liver graft.

<p>Baseline characteristics of the study population at inclusion and quality of the liver graft.</p

Flow chart.

<p>LT: Liver transplantation.</p

Baseline and evolution of the biological parameters of the 50 patients with the 3 time-point available data.

<p>Baseline and evolution of the biological parameters of the 50 patients with the 3 time-point available data.</p