Perioperative Hepatic Blood Flow in relation to Hepatic Regeneration and Function following major Liver Surgery

In high risk liver surgery patients, unhindered and swift liver regeneration is
paramount to successful outcomes. Recent experimental and clinical studies have
shown that alterations in hepatic blood flow is a driving force of liver
regeneration. Patients with insufficient residual mass or disordered
regeneration have an increased risk of severe postoperative complications
including liver failure and death. However, there is currently no evidence or
guidance how alterations in hepatic blood flow can help clinicians to preserve
liver function and enhance liver regeneration after major liver surgery.
Therefore, we want to observe the course of hepatic blood flow, liver function
and liver regeneration after high risk liver surgery.
Furthermore, we aim to identify parameters or patterns associated with
favourable outcomes such as sufficient liver regeneration and preservation of
liver function after high risk liver surgery. The results of this study will
facilitate identification of opportunities to design future intervention
studies to improve outcomes for high-risk liver surgery patients.

Aim of thus study is to observe and correlate the course of hepatic blood flow,
liver function and liver regeneration after high risk liver surgery.
Furthermore we aim to identify ultrasound, liver function and routine
hemodynamic parameters associated with increased liver regeneration after major
liver surgery.

Prospective observational study with invasive measurements

Except the ICG and LiMAx liver function tests and CT-Volumetry scans, there are
no risks associated with participation in this study.
It is known that ICG injection can very exceptionally (<1/10000) cause nausea,
urticarial or an anaphylactoid or anaphylactic reaction. Therefore intravenous
injection will only be performed by -or under direct supervision of- a
physician and will be performed on a hospital ward or ICU.
The LiMAx test uses intravenous injection of 13C-methacetin, a prodrug of
acetaminophen (paracetamol) which will be metabolized to acetaminophen by the
liver. Since intravenous acetaminophen is also routinely used in patients after
high-risk liver surgery, we do not expect an harmful effect of the intravenous
administration of 13C-methacetin.
The CT volumetry scans will give additional radiation exposure. The radiation
exposure has been calculated and presented to the Radiation Exposure Advisory
Board, this evaluation is included in the dossier.