Quantitative Indicators of Hepatic Preservation in Surgical Hepatobiliary Diseases and Postoperative Recovery
DOI:
https://doi.org/10.51699/cajmns.v7i1.3061Keywords:
acute liver failure, liver parenchyma, quantitative coefficient, ischemia, mitochondria, postoperative outcomes, hepatobiliary surgeryAbstract
This study aimed to develop and clinically validate a quantitative indicator of hepatic preservation by using a mitochondrial enzymatic coefficient derived from the ratio of cytochrome C–dependent respiration to TMPD-dependent respiration, and to compare its informativeness with conventional biochemical and morphological assessments in surgical hepatobiliary disease. We used an experimental−clinical approach. Hepatocellular damage was experimentally evoked in rats by DL-galactosamine-plus-carbon tetrachloride (CCl₄) at specific times. Twenty-four surgical patients with hepato-biliary disease were studied in an Operating Unit by taking coagulation biopsies of liver, with transcutaneous needle biopsy, followed by processing in the cold-room, preparing a homogenate and measuring oxygen consumption using a Clark-type electrode system; under the microscope morphological viability was cmpared by examination of live cells stained with trypan-blue vital dye. Routine laboratory tests (bilirubin, ALT/AST, thymol and sublimate test, total protein) had been performed. The estimated coefficient increased uniformly as the viable hepatocytes percentage decreased between both experimental models and clinic observations. Comparable coefficient–viability pairs were also found between experimental and clinical datasets, suggesting cross-context transposable predictions. The traditional liver tests did not significantly correlate with the coefficient, particularly when ALT/AST was fluctuant and/or the bilirubin level largely indicated cholestasis rather than parenchymal preservation. The study introduces a mitochondrial-function–based quantitative coefficient that reflects preserved parenchymal mass more directly than routine biochemical panels. Intraoperative coefficient measurement from biopsy material may support risk stratification, perioperative decision-making, and prediction of postoperative course. Sample size was limited, and the method requires biopsy and specialized polarographic equipment; larger prospective studies are needed to define universal cut-offs and outcome-based thresholds.
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