Abstract
“Small-for-size” livers arising in the context of liver resection and transplantation are vulnerable to the effects of increased portal flow in the immediate postoperative period. Increased portal flow is an essential stimulus for liver regeneration. If the rise in flow and stimulus for regeneration are excessive; however, liver failure and patient death may result. Somatostatin is an endogenous peptide hormone that may be administered exogenously to not only reduce portal blood flow but also offer direct protection to different cells in the liver. In this review article, we describe key changes that transpire in the liver following a relative size reduction occurring in the context of resection and transplantation and the largely beneficial effects that peri-operative somatostatin therapy may help achieve in this setting.
Highlights
The liver is an important organ that fulfills vital functions of metabolism, synthesis, storage, and redistribution of carbohydrates, fats, vitamins, and other nutrients [1]
In the settings of major liver resection and liver transplantation, in particular using reduced-size livers, there is an acute increase in portal vein flow (PVF) to a mass of liver accustomed to lower flow-per-unit of tissue
In the present review article, we discuss the current understanding of key changes occurring in the immediate period following major liver resection and partial liver transplantation and the effects and outcomes that have been achieved following peri-operative administration of somatostatin in these settings
Summary
The liver is an important organ that fulfills vital functions of metabolism, synthesis, storage, and redistribution of carbohydrates, fats, vitamins, and other nutrients [1]. In the settings of major liver resection and liver transplantation, in particular using reduced-size livers, there is an acute increase in portal vein flow (PVF) to a mass of liver accustomed to lower flow-per-unit of tissue. Characterized by progressive cholestasis, coagulopathy, encephalopathy, ascites, gastrointestinal bleeding and/or renal failure, the development of post-operative SFSS/PHLF is associated with high morbidity and short-term mortality rates of up to 80%. For this reason, careful surgical planning is critical to ensure “safe” graft or remnant liver >25–30% of its pre-operative mass or volume in patients with normal livers or >40% in livers that are cirrhotic, cholestatic, steatotic, or injured by chemotherapy [2,3,4,5]. In the present review article, we discuss the current understanding of key changes occurring in the immediate period following major liver resection and partial liver transplantation and the effects and outcomes that have been achieved following peri-operative administration of somatostatin in these settings
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