Ischaemia–reperfusion injury with Pringle's maneuver induces unusually large von Willebrand factor multimers after hepatectomy. Issue 183 (November 2019)

• Record Type: Journal Article
• Authors: Yoshikawa, Takahiro; Nomi, Takeo; Sakai, Kazuya; Hayakawa, Masaki; Hokuto, Daisuke; Matsuo, Yasuko; Sho, Masayuki; Matsumoto, Masanori
• Is Part Of: Thrombosis research. Issue 183(2019)
• Page Start: 20
• Page End: 27
• Publication Date: 2019-11
• Subjects: ADAMTS13 a disintegrin and metalloproteinase with thrombospondin motifs-13 -- CI confidence interval -- CRLM colorectal liver metastases -- ELISA enzyme-linked immunosorbent assay -- OR odds ratios -- SDS sodium dodecyl sulphate -- FFP fresh frozen plasma -- HCC hepatocellular carcinoma -- UL-VWFMs unusually large VWF multimers -- VWF von Willebrand factor; ADAMTS13 -- Unusually large VWF multimers -- Hepatectomy; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2019.09.005
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: von Willebrand factor (VWF) is synthesised in vascular endothelial cells and released into the plasma as unusually large VWF multimers (UL-VWFMs). Sinusoidal endothelial cells are a major target of ischaemia–reperfusion injury due to liver surgery. This study aimed to clarify the effect of hepatectomy on UL-VWFMs. Materials and methods: Thirty-five patients who underwent hepatectomy were eligible for the study. Plasma ADAMTS13 activity and VWF antigen levels were measured by enzyme-linked immunosorbent assay and multimer analysis of plasma VWF was performed according to Ruggeri and Zimmerman's method. For analyses, patients were categorised according to UL-VWFM positivity after hepatectomy. Results: Plasma ADAMTS13 activity significantly decreased from 61.0% (27.7%–126.2%) before operation to 37.4% (20.2%–71.4%) on postoperative day 7 ( p < 0.001). Plasma VWF antigen levels significantly increased from 172.1% (80.5%–412.8%) before operation to 361.0% (154.7%–745.8%) on postoperative day 2, which remained high until postoperative day 7 ( p < 0.001). Seven patients remained UL-VWFMs-negative and 22 patients became UL-VWFMs-positive after operation. Pringle's maneuver duration was significantly longer and blood loss volume was significantly higher in the UL-VWFMs-positive group ( p = 0.001 and p = 0.003, respectively). By multivariable analysis, Pringle's maneuver duration [odds ratio 1.049, 95% confidence interval (CI) 1.001–1.098; p = 0.043] was significantly associated with increased UL-VWFMs level after hepatectomy. UL-VWFMs index was significantly correlated with Pringle's maneuver duration (r = 0.444, p = 0.017). Conclusions: Plasma UL-VWFMs levels increased after hepatectomy due to ischaemia–reperfusion injury with Pringle's maneuver. Highlights: Effect of hepatectomy on UL-VWFMs was investigated for the first time. UL-VWFMs were significantly increased after hepatectomy. UL-VWFMs were significantly correlated with the duration of the Pringle's maneuver.