Liver Function Assessment

Researchers are studying whether high-dose insulin therapy can improve liver function before major liver surgery in patients with colorectal liver metastasis. The trial aims to understand if this therapy enhances liver function pre-operatively, its effects after a liver venous deprivation (LVD) procedure, and the relationship between liver volume growth and function during regeneration. This study is interventional and explores these effects using specialized liver imaging techniques. Participants will receive a 6-hour infusion of insulin and dextrose to maintain a stable blood sugar level before their planned liver surgery. The study has three groups: one receiving insulin therapy before surgery, one receiving insulin therapy after LVD, and one group undergoing LVD without insulin treatment. Insulin dosing is carefully controlled with blood sugar monitoring every 15 minutes during the infusion. During the study, liver function and regeneration will be assessed using 99mTc-Mebrofenin hepatobiliary scintigraphy and CT scans at specific times before and after treatment. Researchers will measure liver function improvements within 24 hours or 7 days post-treatment depending on the group. Participants may be involved in imaging, blood glucose monitoring, and clinical evaluations throughout their participation, which continues until after their liver surgery and follow-up assessments.

Researchers are investigating the effects and mechanisms of the ALPPS procedure on liver regeneration in patients with hepatobiliary cancers, including hepatocellular carcinoma and cholangiocarcinoma. These cancers are aggressive and often diagnosed late. While liver resection offers a chance for cure, success depends on having enough healthy liver left after surgery. ALPPS is a newer surgical method that speeds up liver regrowth, allowing more patients to safely undergo liver removal compared to traditional approaches. The study aims to understand the cellular and genetic changes during liver regeneration caused by ALPPS and how these relate to patient outcomes over time. This observational study involves patients undergoing the ALPPS procedure at a hospital, with no changes made to their standard surgical care. ALPPS involves separating the liver and tying off part of the portal vein to stimulate rapid growth in the remaining liver. Researchers collect liver tissue and medical data during routine care and use advanced techniques like single-cell and spatial transcriptomics to analyze liver cell types and gene activity. The first stage is followed by assessment of liver volume growth before proceeding to the second surgery. Participants will have assessments of their liver volume around 7 and 14 days after the first ALPPS stage, with the main analysis using the last measurement before the second surgery. Researchers will monitor regeneration quality and relate it to short- and long-term clinical outcomes including recurrence. The study collects detailed clinical data and tissue samples without altering treatment, aiming to improve understanding of liver regrowth and inform future therapies. Participation duration depends on surgical timing and follow-up, with safety monitored through standard care.

Researchers are studying the effects of different dialysis parameters on the functional properties of albumin in patients undergoing hemodialysis for end-stage chronic kidney disease. This condition requires hemodialysis to survive but is associated with increased cardiovascular risks due to chronic inflammation and incomplete removal of toxins. The study aims to explore how dialyzer types and dialysis modes can therapeutically improve albumin function and overall treatment quality. Participants will receive treatments involving hemodialysis, hemodiafiltration, high-flux dialyzers, and low-flux dialyzers, each for a period of three months. This proof-of-concept interventional study will assess how these different dialysis approaches affect albumin's ability to bind and detoxify harmful substances. The study focuses on comparing the effects of dialysis mode and dialyzer characteristics over a total duration of nine months. Throughout the study, researchers will measure the level of irreversibly oxidized albumin (HNA-2) and evaluate albumin's binding and detoxification efficiency at the end of nine months. Participants will be monitored regularly during treatment to assess these outcomes. The study is sponsored by Universität Duisburg-Essen and aims to provide insights into improving long-term hemodialysis treatment quality by modifying albumin functions.

Researchers are collecting data from patients undergoing liver surgery for benign liver tumors, primary liver cancer, or secondary liver cancer at Institut Paoli-Calmettes. This observational study aims to create a database to describe the epidemiology of these patients over a period of 5 years. The research helps improve understanding of liver surgery outcomes in different patient groups. The study involves collecting detailed information before, during, and after liver surgery. This includes pre-operative, surgical, and post-surgical data from patients treated at Institut Paoli-Calmettes. There are no experimental treatments, as the study focuses on gathering and analyzing medical data related to liver surgeries. Participants will have their medical and surgical information recorded and monitored as part of routine care. Researchers will analyze this data to describe patterns and outcomes associated with liver surgeries. The study is planned to continue until November 2030, allowing for long-term data collection and follow-up. Participation does not involve additional procedures beyond standard surgical care.

Introduction: Postoperative delirium (POD) is a common complication in elderly surgical patients and is significantly associated with prolonged hospital stays, cognitive impairment, functional decline, and increased mortality rates within 6 to 12 months. Its incidence has been reported to range between 10% and 70%, depending on the diagnostic criteria used, the population studied, and the type of surgical procedure performed. The incidence is particularly higher following vascular, cardiac, and hip fracture surgeries. According to the 2024 updated guidelines by the European Society of Anaesthesiology and Intensive Care (ESAIC), POD should be screened at least once daily for a minimum of three days, beginning in the post-anesthesia recovery unit, based on the DSM-5 criteria. POD is a complex syndrome associated with various phenotypes and is likely the result of a combination of neuroinflammatory and oxidative stress processes. Candidate biomarkers for POD include inflammatory parameters (such as interleukins, C-reactive protein \[CRP\], erythrocyte sedimentation rate, and CD68), dopamine receptors, norepinephrine levels, cortisol levels, genetic biomarkers (e.g., apolipoprotein E4), acetylcholinesterase levels, and albumin levels. However, systemic stress can lead to nonspecific activation of the immune system, resulting in a decrease in lymphocyte count. Although the relationships between CRP, albumin, and lymphocyte count with POD have been individually investigated in the literature, no study has examined the combined effect of these three parameters. Based on this, we aimed to investigate whether the CRP-Albumin-Lymphocyte (CALLY) Index, a novel index not previously reported in the literature, is effective in predicting POD in geriatric patients with hip fractures. The CALLY Index is calculated using the formula: (Albumin × Lymphocyte) / (CRP × 10⁴). Aim/Hypothesis: H₀: The CALLY Index cannot predict the risk of postoperative delirium in geriatric patients undergoing hip fracture surgery. H₁: The CALLY Index can predict the risk of postoperative delirium in geriatric patients undergoing hip fracture surgery. Material-Methods: The following data will be recorded for each patient: * Demographic variables: age, sex, height, weight, and body mass index (BMI) * American Society of Anesthesiologists (ASA) physical status classification * Comorbidities and medication use * Smoking and alcohol consumption history * Preoperative laboratory parameters: obtained from the hospital information system for CALLY Index calculation * Perioperative variables: type and duration of anesthesia, duration of surgery, type of surgical procedure, estimated blood loss, blood product transfusion status, and occurrence of intraoperative adverse events * Postoperative data: * Ward of admission after surgery (orthopedic ward/intensive care unit) * Presence of delirium, assessed twice daily (morning and evening) for three days using DSM-5 criteria, starting in the post-anesthesia recovery unit * Occurrence of postoperative complications * Length of stay in the intensive care unit * Total hospital length of stay * Mortality status Patients aged 65 years and older who undergo surgery for femoral neck or intertrochanteric fractures will be included in the study. Patients with preoperative delirium, preoperative dementia, pathological or open fractures, systemic or localized infections in the fracture region during the preoperative period, or multiple trauma will be excluded. Additionally, those with a BMI \<18.5 or ≥35 chronic organ failure, or advanced-stage cancer will be excluded from the study.

Researchers are studying how the body produces carbon monoxide (CO) after part of the liver has been surgically removed. The study focuses on measuring CO levels in breath as a way to understand how well the liver regenerates and to predict possible liver-related complications after surgery. This research aims to better monitor liver healing and assess liver function following surgery. All participants will provide breath samples to measure carbon monoxide levels before surgery, then again 4 hours and 24 hours after liver resection. The study will track these CO levels alongside the amount and quality of liver regeneration over time. Liver volume and function will be assessed at one and three months after the surgery to correlate with the CO measurements. Participants will be monitored through breath tests and follow-up visits to measure liver regeneration and function. Researchers will collect data on CO levels in exhaled air and compare them to liver volume and function results. The main outcome is to find a link between CO levels and liver healing, which may help predict liver-related health issues after surgery. The study is expected to continue until 2039.

Researchers are studying the effects of enhanced perioperative pulmonary physiotherapy on reducing postoperative pulmonary complications (PPCs) after laparoscopic liver surgery. PPCs include respiratory infections, atelectasis, pleural effusion, bronchospasm, aspiration pneumonitis, pneumothorax, exacerbations of chronic lung conditions, and respiratory failure, which can cause significant health issues and costs. This multicenter, randomized controlled trial aims to evaluate whether a short, easy-to-integrate physiotherapy program can lower PPC rates compared to standard perioperative care. The study compares two groups: one receiving enhanced pulmonary physiotherapy involving a preoperative session, an educational video, and daily exercises including deep breathing, coughing, pursed lip breathing, and positive expiratory pressure (PEP) therapy performed twice daily for 14 days (7 days before and 7 days after surgery). The control group receives standard perioperative breathing education based on Enhanced Recovery After Surgery (ERAS) protocols. Surgeons and researchers are blinded to group allocation to reduce bias. Participants will be assessed before surgery, at discharge, and 30 days postoperatively. Data collected include patient characteristics, surgical details, and postoperative outcomes such as PPC incidence within 14 days, length of hospital and ICU stays, antibiotic use, complications, mortality up to 90 days, and hospital costs. Compliance with the physiotherapy program will be monitored. The total participation duration covers preoperative preparation through 90 days of postoperative follow-up.

This trial focuses on patients hospitalized with acute decompensation of chronic heart failure (CHF), who often experience worsening renal function (WRF) leading to resistance to diuretics and poor outcomes. Researchers are investigating if CHF patients with liver dysfunction, who produce less albumin, are more prone to WRF. The study evaluates whether adding intravenous human albumin to standard IV loop diuretics improves diuretic effectiveness and protects kidney function in these patients. Participants are randomly assigned to receive either a continuous slow intravenous infusion of human albumin combined with IV furosemide or IV furosemide alone. The human albumin infusion is adjusted based on urine output and starts within 30 minutes after randomization and within 2 hours of hospital admission. Both groups receive diuretics adjusted by body weight and urine output. The study treatment lasts for at least 72 hours. During the study, researchers will assess symptoms and changes in serum creatinine levels from baseline to 72 hours. Additional measures include patient-reported breathlessness, body weight changes, fluid loss, length of hospital stay, and a composite outcome of death, rehospitalization, treatment escalation, or emergency visits up to 180 days after discharge. Participants are closely monitored with laboratory and imaging tests to evaluate liver function and kidney status throughout the study period, which is expected to continue until December 2026.

Postoperative intra-abdominal infection is a serious complication following pancreatic surgery, which can lead to significant suffering, longer hospital stays, and potentially life-threatening conditions like sepsis. Researchers are studying whether preventive use of antibiotics during surgery, guided by serum lactate level changes on the first day after surgery, can reduce the rate of these infections. This study aims to confirm previous findings that a peak serum lactate level above 3.25 mmol/L within 24 hours after surgery predicts infection risk. Participants with a peak serum lactate level over 3.25 mmol/L on postoperative day one will be randomly assigned to one of two groups. One group receives advanced antibiotics (Sulperazon 3g every 8 hours) for five days after surgery, while the other group receives routine antibiotics (Cefmetazole 1g every 12 hours) for three days. This randomized controlled trial compares infection rates and other outcomes between these two preventive antibiotic strategies. During the study, researchers will monitor participants for 30 days after surgery, assessing the incidence of intra-abdominal infection as the primary outcome. Additional blood tests will track white blood cell counts, procalcitonin, C-reactive protein, interleukin, and tumor necrosis factor alpha levels at multiple points up to 28 days post-surgery. The study also evaluates complications, hospital costs, and overall recovery to determine if advanced antibiotics improve patient outcomes after pancreatic resection.

Researchers are investigating the effect of Pentoxifylline on liver regeneration in live donors undergoing major liver surgery called right lobe donor hepatectomy. This study aims to analyze how Pentoxifylline supplementation affects anatomical liver growth, building on previous research showing its potential benefits in liver regeneration and protection after liver surgery. The trial is a randomized controlled trial conducted at a high-volume liver transplant center in India. Participants receive either an intravenous injection of Pentoxifylline at a dose of 1 mg/kg/hr dissolved in Plasma Lyte or 0.9% normal saline, starting 12 hours before surgery and continuing up to 72 hours after surgery, or intravenous fluid Plasmalyte as a comparator. The intervention period covers the perioperative phase around the surgery. During the study, participants will be monitored for liver volume regeneration two weeks after surgery, along with various blood markers related to liver function and regeneration measured up to two weeks post-operation. These include serum bilirubin, liver enzymes (AST, ALT, alkaline phosphatase, GGT), coagulation status (INR), growth factors, and inflammatory markers such as TNF-alpha, IL-6, and TGF-beta. Researchers will also observe any postoperative complications. The total follow-up includes assessments primarily on postoperative days 7 and 14.