ROLE OF ADHESION MOLECULE EXPRESSION AND SOLUBLE FRACTIONS IN HEPATICRESECTION

Background: Little has so far been documented about the relationship b etween liver injury and adhesion molecules. The aim of this study is t o clarify the role of adhesion molecules in hepatic resection by study ing both the expression of such adhesion molecules and the measurement of their soluble fractions in the blood. Study Design: To study adhes ion molecule expression in the liver, liver biopsies were obtained bef ore and after hepatectomy in 14 patients. Using frozen sections, immun ochemical staining for intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) was then performed. To stud y the soluble fractions of adhesion molecules in the hepatic venous bl ood, the serum soluble fractions of ICAM-1 and VCAM-1 from another 17 patients were measured using an enzyme-linked immunosorbent assay. The plasma levels of polymorphonuclear leukocyte (PMN) elastase mere also measured using an enzyme immunoassay. Both the preoperative and posto perative values of the serum soluble fractions of ICAM-1, VCAM-1, and PMN elastase were then compared. The correlation between their values and the perioperative variables was also investigated. Results: Either ICAM-1 or VCAM-1 was stained on the sinusoidal endothelial cells and Kupffer cells or circulating PMNs in the sinusoid. The positive rate o f either ICAM-1 or VCAM-1 staining in livers with more than 40 minutes of total ischemic time (80%) was significantly higher than that in li vers with less than 40 minutes of total ischemic time (0%; p < 0.05). The incidence of postoperative complications in the ICAM-1 positive st aining group tended to be higher than that in the ICAM-1 negative grou p. Both soluble fractions of ICAM-1 and VCAM-1 in patients with cirrho tic liver disease were also significantly higher than those in patient s with a normal liver. The soluble VCAM-1 level in patients with a chr onic active hepatitic liver tended to be higher than that in those wit h a nonactive hepatitic liver. The preoperative level of soluble ICAM- 1 correlated with that of VCAM-1, PMN elastase, albumin, aspartate ami notransferease (AST), and the indocyanine green dye retention test at 15 minutes (ICG R-15), while the preoperative level of VCAM-1 correlat ed with albumin, the hepaplastin test, AST, and ICG R-15. Both the ser um soluble ICAM-1 and VCAM-1 levels after hepatectomy were significant ly lower than those before hepatectomy. By contrast, the posthepatecto my level of PMN elastase was significantly higher than its prehepatect omy level. The difference between the postoperative and preoperative v alues of soluble ICAM-1 correlated with the postoperative AST level, p ostoperative alanine aminotransferase level, and total ischemic time. Conclusions: Adhesion molecules were expressed in the liver after hepa tic resection, and such expression correlated with a total ischemic ti me during hepatectomy. In addition, judging from the soluble forms of such molecules, these adhesion molecules play an important role in hep atic resection. (C) 1998 by the American College of Surgeons.