Of note, the survey disclosed a minimal residual volume of 50% (range: 25%-90%) after MAPK Inhibitor Library datasheet resection in the population of patients with cirrhosis, highlighting the negative impact of preexisting disease.7, 8 A few authors have correlated the extent

of liver resection with subsequent postoperative outcome.6, 9-13 Two reports demonstrated a dramatic increase in the rates and severity of complications after major resections with remnant livers < 20%,12, 13 whereas the group from Edinburgh,6 using the score mentioned above, proposed a safety cutoff of 27% for the remnant liver mass (Fig. 2). In transplantation, a number of studies have suggested that grafts should be considered for LDLT only if the GRWR is higher than 0.8,14-17 which explains the consistent reply in the survey, and the wide acceptance of this lower limit.7 Many risk factors are incriminated to affect outcomes Cabozantinib in liver surgery and transplantation (Table 1). Because of space limitation, we will focus on age, liver steatosis, and exposure to chemotherapy, because those are frequently encountered in our patients. Strong evidence from basic18-21 as well as clinical22, 23 studies exist that liver regeneration is impaired in old livers. The

underlying mechanisms have only been partially identified. Down-regulation of several key molecules during aging ultimately lead to changes in several cyclins, that arrest cells in the cell cycle. Growth hormone seems to reverse these age-associated

alterations.20, 21 In a rodent model, old animals demonstrated delayed regeneration after partial hepatectomy, which could be corrected to the range of young animals by the addition of growth hormone. This treatment activated cyclin-dependent kinases and down-regulated its inhibitors, enabling the progression in the cell cycle which is required for liver regeneration. In a study in patients who have undergone LDLT, serial volumetric analyses showed delayed liver regeneration in older selleck screening library donors. Donors older than 50 years of age disclosed significantly smaller volumes 1 week after resection compared to young (<30 years) individuals. However, volume eventually returned to normal sizes by 1 month after resection.22 Not only the regenerative capacity decreases with age, but also liver volume24-26 and liver hepatic microcirculation.27 In addition, a so-called “pseudocapillarization”28 of the sinusoids has been observed with advancing age which consists of a thickening of the endothelial lining and loss of the fenestrae.29 This combination may explain the known impaired clearance of a number of drugs in the elderly population.30, 31 Although speculative, this might also influence liver regeneration. Despite all these changes, the liver architecture seen in conventional histological examination does not differ between young and old individuals.