Perioperative Von Willebrand Factor Dynamics are Associated with Liver Regeneration and Predict Outcome after Liver Resection.

Starlinger, Patrick; Pereyra, David; Haegele, Stefanie; Braeuer, Paul; Oehlberger, Lukas; Primavesi, Florian; Kohler, Andreas; Offensperger, Florian; Reiberger, Thomas; Ferlitsch, Arnulf; Messner, Barbara; Beldi, Guido; Staettner, Stefan; Brostjan, Christine; Gruenberger, Thomas (2018). Perioperative Von Willebrand Factor Dynamics are Associated with Liver Regeneration and Predict Outcome after Liver Resection. Hepatology, 67(4), pp. 1516-1530. Wiley Interscience 10.1002/hep.29651

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Von Willebrand Factor (vWF) was found to mediate platelet influx during the early phase of liver regeneration in mice. Further, increased vWF-antigen (vWF-Ag) levels were shown to be predictive for outcome of patients with chronic liver disease. Accordingly, we aimed to assess the relevance of perioperative vWF-Ag dynamics in terms of liver regeneration and clinical outcome in patients undergoing liver resection (LR). Accordingly, we observed that vWF-Ag and its activity - estimated via ristocetin cofactor measurement - increased immediately after induction of liver regeneration and was associated with platelet accumulation within the liver. However, a significant vWF-Ag burst was only observed in patients with unaffected postoperative liver regeneration. E-selectin, as an established marker for endothelial cell activation, was found to correlate with vWF-Ag in the liver vein after induction of liver regeneration (P=0.022). Preoperative vWF-Ag levels significantly predicted postoperative liver dysfunction (LD) (N=95, AUC:0.725, P=0.009). Furthermore, a cut-off of vWF-Ag≥182% was defined to identify patients with a higher risk for postoperative LD or morbidity. This was confirmed within an independent mulitcenter validation cohort (N=133). Ultimately, multivariable analysis revealed that vWF-Ag was an independent predictor of postoperative LD and morbidity. CONCLUSION Within this study we were able to provide evidence that an initial vWF burst is required to allow for adequate platelet accumulation and concomitant liver regeneration after LR and might be abolished as a consequence of intrahepatic endothelial cell dysfunction. We were further able to reveal and validate the potential of preoperative vWF-antigen levels to predict poor postoperative outcome in patients undergoing LR. Despite the pathophysiological relevance of our findings, vWF-Ag seems to be a valuable tool for preoperative risk assessment in patients undergoing LR. This article is protected by copyright. All rights reserved.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
04 Faculty of Medicine > Faculty Institutions > Teaching Staff, Faculty of Medicine

UniBE Contributor:

Kohler, Andreas and Beldi, Guido

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0270-9139

Publisher:

Wiley Interscience

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

08 Mar 2018 13:44

Last Modified:

18 Nov 2019 04:10

Publisher DOI:

10.1002/hep.29651

PubMed ID:

29140542

Uncontrolled Keywords:

Liver Dysfunction Liver Resection Morbidity Mortality Platelets von Willebrand Factor Antigen

BORIS DOI:

10.7892/boris.109045

URI:

https://boris.unibe.ch/id/eprint/109045

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