Mechanistical Insights – Liver Regeneration
“The most relevant factor determining postoperative outcome represents the ability of the remnant liver to regenerate”
During the past few years we focused on improving our understanding of liver regeneration in humans. While extensive research has been performed in mice, very little is known about the relevance of these findings in humans. Accordingly, we set up a prospective, detailed, systematic bio banking of our patients undergoing liver resection, assuring highest quality standards for sample preparation.
As a result we were able to explore some aspects of the process of liver regeneration also in humans – which is an indispensable prerequisite to also find new therapeutic targets to promote liver regeneration.
Selected publications on liver regeneration
Cancer behaves like a chronic healing wound – wouldn’t you expect that supporting liver regeneration supports tumor recurrence within the liver?
Well that is probably very true. However, one has to note that patients that develop postoperative severe morbidity also suffer from early tumor recurrences. Nevertheless, we have been addressing this issue during the past few years in our lab. What was quite striking to note, was that indeed growth factors might have a dual role in liver surgery. Some do indeed promote liver regeneration, but also account for early tumor recurrences. Accordingly, it is critical to find an optimized balance or timing to support liver regeneration but avoid a concomitant induction of tumor regrowth.
Preoperative Risk Assessment
Remember your last patient developing liver failure after liver resection?
Preoperative risk assessment is critically relevant in HB surgery. Usually we have been evaluating certain target molecules but we have recently also started to preform multiple systematic Omics based approaches to identify new markers that can help us to risk stratify patients easily prior to surgery. This will allow us in the future to collect a simple blood specimen from the patient and they personalize therapeutic decision to each individual patient.
Most relevant publication of our group concerning PreOP risk assessment
Postoperative Risk Assessment
When you arrive at the intensive care unit in the morning after major liver surgery, wouldn’t you want you know if this patient is at high risk to develop postoperative liver dysfunction, morbidity or might even develop liver failure or might die?
While ideally patients risk is predicted preoperatively, patients at high risk for developing postoperative liver dysfunction may also be identified early after liver resection. This is of critical relevance to allow for early induction of supportive measures and also for the development of new therapeutic approaches.