The Ratio of Activin A and FLRG Allows Prediction of Postoperative Liver Dysfunction in Patients Undergoing Liver Resection

Abstract

Introduction: Postoperative liver dysfunction (LD) remains a life-threatening complication after liver resection. With no causal therapy available, research focusing on understanding postoperative liver regeneration (LR) and the prediction of postoperative LD is of importance. Here, we evaluate the predictive potential for postoperative LD of activin A and its inhibitory protein FLRG and assess their influence on the development of LD. Method: Activin A and FLRG were evaluated in plasma of 59 patients undergoing liver resection using commercially available ELISA kits. Plasma was prepared from blood taken prior to the operation (preOP), as well as on the first and fifth postoperative day (POD). Postoperative outcome was prospectively documented. Results: When evaluating the perioperative dynamic of activin A and FLRG, we observed a significant decrease in plasma for both parameters on POD1 (p=0.045 and p=0.005, respectively). FLRG showed an increase from POD1 on POD5 (p=0.004). Interestingly, neither activin A nor FLRG were different between patients with and without postoperative LD at any timepoint. However, the ratio activin A / FLRG was significantly higher in patients without LD prior to liver resection (p=0.037). There was no perioperative dynamic for activin A / FLRG. Conclusions: While the circulating dynamics of activin A and FLRG showed no association with LD, the ratio of activin A / FLRG was significantly decreased in patients developing postoperative LD prior to liver resection. While the pathophysiology behind these findings still warrants further research, activin A shows potential as a possible predictor of postoperative LD.