Adipocytokines in Steatotic Liver Surgery/Transplantation.

Due to the shortage of liver grafts available for transplantation the restrictions on graft quality have been relaxed and marginal grafts such as steatotic livers are now accepted. However, this policy change has not solved the problem, because steatotic liver grafts tolerate ischemia-reperfusion injury poorly. Adipocytokines differentially modulate steatosis, inflammation, and fibrosis and are broadly present in hepatic resections and transplants. The potential use of adipocytokines as biomarkers of the severity of steatosis and liver damage to aid the identification of high-risk steatotic liver donors and to evaluate hepatic injury in the postoperative period are discussed. The hope of finding new therapeutic strategies aimed specifically at protecting steatotic livers undergoing surgery, is a strong impetus for identifying the mechanisms responsible for hepatic failure after major surgical intervention. Hence, the most recently described roles of adipocytokines in steatotic livers subject to ischemia-reperfusion injury are discussed, the conflicting results in the literature are summarized, and reasons are offered as to why strategic pharmacologic control of adipocytokines has yet to yield clinical benefits. Following this, the next steps needed to transfer basic knowledge about adipocytokines into clinical practice in order to protect marginal livers subject to ischemia-reperfusion injury are presented. Recent strategies based on adipocytokine regulation which have shown efficacy in various pathologies, and hold promise for hepatic resection and transplantation are also outlined. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.

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