Serum Hyaluronic Acid Level Reflects Volume and ATP Levels of the Liver after Extended Hepatectomy with and without Preoperative Portal Vein Occlusion

Abstract

The purpose of this study was to examine the hypothesis that the serum hyaluronic acid (HA) level reflects the volume and adenosine triphosphate (ATP) levels of the liver after extended hepatectomy (ExHx) with and without preoperative portal vein occlusion (PVO). Rats were randomly divided into two groups, PVO-ExHx and sham-ExHx. At the first stage, they underwent PVO or sham surgery by an occlusion of the portal vein supplying the left lateral and median lobes or by similar manipulation but without PVO, respectively. Seven days after first-stage surgery, both groups received ExHx exceeding portal vein-occluded lobes, which was the excision of the left lateral, median, and right lateral lobes of the liver reported as a 90% hepatectomy model. On Days 0, 1, 2, and 3 after ExHx, the serum HA concentrations, liver weights, and hepatic ATP levels were determined. Liver volumes were restored to similar levels in both groups, but restoration was faster in the PVO-ExHx group because preoperative PVO allowed the excised liver less volume. Lower serum HA levels were significantly associated with significantly higher hepatic ATP levels and with a lower mortality rate in the PVO-ExHx group. The serum HA level correlated significantly (P< 0.001) with the liver weight and hepatic ATP level. The serum HA level serves as a proxy for clinically important parameters following major hepatic surgery.