Vascular endothelial growth factor does not improve liver regeneration and survival after 90% subtotal liver resection.

AIM: Vascular endothelial growth factor (VEGF) has been shown to stimulate liver regeneration after 70% partial hepatectomy (PH). It is unclear, however, whether exogenous administration of VEGF can also be used to improve liver regeneration and survival after 90% subtotal liver resection. The aim of this study was to determine the effect of exogenous and endogenous VEGF after 90% subtotal hepatectomy (SH). METHODS: Rats were subjected to 90% SH and treated with VEGF, anti-VEGF or NaCl. Postoperatively (3 h - 5 days) liver body weight ratio (LBR), hepatocyte proliferation and biochemical markers were assessed. ELISA was performed to measure protein levels for VEGF. Gene expression was determined by customized cDNA arrays and quantitative RT-PCR. RESULTS: Administration of VEGF did not enhance LBR or hepatic proliferation, or reduce the serum parameters. VEGF levels were the highest in VEGF-treated animals. The overall survival after 90% SH reached 78% in VEGF-treated animals, but did not differ significantly from that of anti-VEGF or NaCl-treated animals (74% and 75%, respectively). Gene expression analysis showed a modulation of anti-apoptotic and cell cycle control genes that was independent of VEGF. CONCLUSIONS: In contrast to PH, liver regeneration and survival after SH cannot be modulated by VEGF. This indicates that the relevant mechanisms that stimulate liver regeneration after hepatectomy at least partially depend upon the extent of liver resection.

Severe neurological events following liver transplantation.

BACKGROUND: Problems related to the central nervous system may have major impact on morbidity and mortality. The aim of this retrospective study was to evaluate the nature and incidence of serious neurologic events in patients following liver transplantation. METHODS: Between January 2001 and May 2004, 168 patients (105 female, 63 male) requiring transplantation for alcoholic cirrhosis, hepatitis B and C, and acute liver failure were admitted to the Intensive Care Unit (ICU) of University Hospital Essen after liver transplantation. We identified the reason for the neurologic events, the underlying disease, type of immunosuppression, and the survival rate. RESULTS: Severe neurologic events occurred in 46 (27.3%) of the patients. The length of stay of these patients in the ICU (18.4 +/- 19.7 days) was longer in comparison to the total patients (8.3 +/- 9.5 days, p < 0.05). The most common neurological complications were encephalopathy (18.5%) and seizures (5.4%). The survival rate after liver transplantation with neurological events was lower compared to patients without, but not significantly different (73.9 vs. 79.5%). The calcineurin inhibitor used had no impact on neurological events [cyclosporine (25.5%); tacrolimus (32.5%)]. CONCLUSIONS: There was a high incidence of serious neurologic events after liver transplantation. The major neurologic manifestation in our patients was encephalopathy followed by seizures.