Intraabdominelle Infektionen beeinträchtigen Regeneration und Funktion der Leber nach erweiterter Resektion

Postoperative infections represent a major problem after hepatic surgery. Although clinical observations indicate, that septic conditions may alter liver regeneration, no systematic investigations are available. Methods: Male SD-rats underwent Sham operation, 70 % liver resection (LR), ceocal ligation and puncture (CLP) or synchronous LR and CLP. Rats were sacrificed 6 to 96 h after operation. The following regeneration parameters were analyzed: relative liver weight, mitotic index, BrdU labeling and Ki-67 index. For determination of liver function serum parameters (thromboplastine time, bilirubin, albumin) were measured as well as the ICG-clearance pre- and postoperatively several times. The inflammatory response was evaluated by determination of IL-1β, TNF-α, IL-6 and myeloperoxidase activity. Bacterial concentrations in different organs were quantified using microbiological standard methods. Results: The regeneration process of the liver was significantly delayed by synchronous CLP. Whereas in the LR group the maximum prolifaratory response was observed 24 h after resection, the LR+CLP group revealed a significantly lower peak of proliferation, which was delayed by 24 h.However, the proliferative activity in the LR+CLP group was persistently elevated until 96 h. Liver function was markedly impaired in both groups, but it was significantly worse in the LR+CLP group. Especially after 48 h, when regeneration peaked after LR+CLP, liver function significantly declined in this group. The inflammatory mediators were elevated 6h after LR+CLP, whereas bacterial concentrations were relatively low at this time. Conclusion: The present systematic analysis shows, that infectious conditions can significantly delay liver regeneration. The data suggest, that both conditions are cross linked via the functional capacity of the liver. A direct role of microorganisms seems very unlikely, however an inhibitory effect of several cytocines, especially IL-1β might also be involved.