The following is a summary of “Early Postoperative Serum Phosphate Drop Predicts Sufficient Hypertrophy After Liver Surgery,” published in the November 2023 issue of Surgery by Kambakamba, et al.
For a study, researchers sought to determine what effect hypophosphatemia had on liver healing after major liver surgery. They looked at Associating Liver Partition with Portal vein ligation for Staged hepatectomy (ALPPS) and living liver donation (LLD). Low phosphatemia has been linked to the metabolic needs of hepatocytes that are renewing themselves. Both ALPPS and LLD cause the liver to regenerate very quickly and may be especially useful for people who have had a liver transplant and are experiencing low phosphatemia.
They looked at changes in serum phosphate levels in the first week after ALPPS (n=61) and LLD (n=54) surgeries. These changes were compared to standardized volumetry after one week. In a translational method, changes in phosphate levels after surgery were studied in a lab dish. After ALPPS stage 1 and LLD, blood phosphate levels dropped a lot. They went from a median of 1.08 mmol/L [IQR] (0.92–1.23) and 1.07 mmol/L (IQR 0.91–1.21) before surgery to a median low of 0.68 mmol/L and 0.52 mmol/L after surgery, respectively.
A big drop in phosphate was strongly linked to more liver enlargement (P<0.001). Post-hepatectomy liver failure was more common in people with a low drop of phosphate (7% vs. 31%) after ALPPS. In ALPPS and hepatectomy models, phosphate drop was strongly linked to the level of swelling, just like it is in people (P<0.001). In vitro, blocking phosphate transporter (Slc20a1) stopped cells from taking in phosphate and stopped hepatocytes from growing. The phosphate drop after liver removal is a direct sign of liver enlargement. Implementing blood phosphate research before surgery could help find people who cannot heal themselves properly early on.
