Human liver regeneration: Hepatic energy economy is less efficient when the organ is diseased

Recovery of liver cell mass following hepatectomy requires a metabolic comp romise between differentiated function and organ regrowth. Clinical experie nce has shown that hepatic failure after resection is more common when the organ is diseased. We have evaluated intracellular hepatic biochemistry in patients with normal and cirrhotic livers undergoing partial hepatectomy, u sing 31-phosphorus magnetic resonance spectroscopy (P-31 MRS). Eighteen pat ients were studied, half with normal liver architecture (normal group, n = 9) and half with cirrhotic parenchyma (cirrhosis group, n = 9). Magnetic re sonance examinations were performed preoperatively and on postoperative day s 2, 4, 6, 14, and 28. Hepatic volume (estimated by magnetic resonance imag ing [MRI]) and blood chemistries were measured at the same intervals. Follo wing a comparable reduction in parenchymal volume, the cirrhotic group demo nstrated a more sustained fall in adenosine triphosphate (ATP) energy state . Disturbance of membrane phospholipid metabolism and duration of acute-pha se reaction were more marked when the liver was diseased. The pattern of de rangement of hepatic function, however, was similar in the two groups. Over all, the recovery process was less efficient in the cirrhotic organ, and cu lminated in a diminished rate and extent of the regenerative response. Thes e outcomes indicate that liver regeneration after partial hepatectomy invol ves modulation of hepatic energy economy in response to changing work deman ds. The efficiency of this process is influenced by the histopathologic sta te of the organ, and in turn governs the physiologic reserve. These finding s may explain the mechanism of posthepatectomy liver failure, and offer a r ational basis for the assessment of novel hepatic support strategies.