Serum levels of endothelin-1 after liver resection as an early predictor of postoperative liver failure. A prospective study

Aim: Besides the residual liver volume, damage of the microcirculation secondary to increased portal blood flow is a main determinant of postoperative liver failure (PLF). Endothelin-1 (ET-1), produced by sinusoidal endothelial cells, plays a key role in the regulation of hepatic microcirculation. The aim of this study was to determine whether ET-1 levels has any prognostic utility in predicting PLF. Methods: Patients undergoing liver resection for primary or secondary liver tumors at San Raffaele Hospital, Milan, were prospectively enrolled in the study. Serial postoperative serum ET-1 levels in patients undergoing liver resections were correlated with indices of inflammatory response, liver failure and death. Results: A total of 144 patients were included. ET-1 levels in patients who underwent major or extended liver resection were significantly higher than in patients who had a minor resection on postoperative day (POD) 1 (P=0.003), POD 2 (P=0.0001) and POD 5 (P=0.0001). Eight patients developed PLF and ET-1 was significantly higher compared with patients without PLF on POD 2 (P=0.002) and POD5 (P=0.006). Serum ET-1 concentration on POD 2 was an independent predictor of PLF in multivariate analysis. Conclusion: ET-1 is as an early index of PLF and provides a rationale for therapeutic manipulation, with many potential clinical implications to prevent PLF onset and reduce its severity.