Early Postoperative Serum Phosphate Drop Predicts Sufficient Hypertrophy After Liver Surgery

Area of Science:

• Hepatobiliary Surgery
• Transplantation
• Regenerative Medicine

Background:

• Hypophosphatemia is linked to the metabolic demands of regenerating hepatocytes.
• Associating Liver Partition with Portal vein ligation for Staged hepatectomy (ALPPS) and living liver donation (LLD) involve significant liver regeneration.
• Understanding posthepatectomy phosphate changes is crucial for these procedures.

Purpose of the Study:

• To evaluate the impact of postoperative hypophosphatemia on liver regeneration.
• To assess liver regeneration after major liver surgery (ALPPS and LLD).
• To correlate serum phosphate levels with liver hypertrophy and outcomes.

Main Methods:

• Prospective assessment of serum phosphate changes in ALPPS (n=61) and LLD (n=54) patients within 7 days post-surgery.
• Correlation of phosphate levels with standardized liver volumetry.
• Translational investigation in murine models and in vitro studies.

Main Results:

• Significant phosphate drop observed post-ALPPS and LLD, correlating with increased liver hypertrophy (P <0.001).
• Lower phosphate drop associated with higher incidence of posthepatectomy liver failure after ALPPS (31% vs 7%, P =0.041).
• Phosphate drop and hypertrophy correlation confirmed in murine models; Slc20a1 inhibition reduced hepatocyte proliferation in vitro.

Conclusions:

• Postoperative phosphate drop serves as a direct marker for liver hypertrophy.
• Serum phosphate analysis can detect patients with inadequate regenerative capacity early.
• This monitoring aids in managing patients undergoing major liver resection.