Correlation Research Between The Different Types Of The Liver Cells And Liver Regeneration After ALPPS

Objective:Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)can greatly accelerate liver regeneration.This paper mainly explored the relationship between different types of liver cells and liver regeneration after ALPPS operation,providing a basis for clarifying the mechanism of liver regeneration related to ALPPS.Methods:A retrospective analysis of liver cancer patients who underwent ALPPS treatment at the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Guangxi Medical University from January 2018 to June2020,collected clinical data of the patients,and collected the required liver histological specimens.Perform preliminary summary and statistical analysis of clinical data,and screen out 26 suitable cases that have completed ALPPS-II.Quantitative analysis of various types of cells in the regenerative liver tissue of patients with ALPPS stage I and stage II using multicolor immunofluorescence staining and multi-spectral imaging techniques.The detection time points include the left liver of ALPPS-I open,ALPPS-I closed and ALPPS-II.The cell types detected include Hepatocytes,Biliary epithelial cells(BEC),Liver stem cells(LSC),Hepatic stellate cells(HSC),and Liver sinusoidal endothelial cells(LSEC),Kupffer cells,pit cells and proliferation antigen Ki67 and SOX9 markers related to liver cell regeneration.Analyze the expression trends of the 9cell types at three different time points.Then,based on the imaging data re-examined within 14 days after ALPPS-I,the future liver remnant was calculated.Assess whether future liver remnant meets the criteria for second-stage surgery.Calculate its daily dynamic growth rate(KGR)by formula.Using the median of KGR as the boundary,they were divided into two groups of high and low KGR,and the expression of different types of cells in the two groups of high and low KGR was further analyzed.Results:Comparison of positive expression rates in various liver cells between ALPPS-I stage open and ALPPS-I stage closed shows a significant decrease in sinus endothelial cells(P=0.026),while there is no significant difference in the change of other cells.Compared with ALPPS-I stage closed,Kupfer cells showed a trend of increasing at ALPPS-Ⅱ and the difference was statistically significant(P=0.036).In addition,Ki67+ cells have significant differences in ALPPS-Ⅱ phase compared with ALPPS-Ⅰ open and ALPPS-Ⅰclosed respectively,which proves that the regeneration of the liver is obvious.There is no significant difference in the results of other types of cells(P>0.05).Furtherly,according to the liver hyperplasia after ALPPS-Ⅰ stage,the patients were divided into high and low KGR groups for comparison.High KGR represented the rapidly proliferating liver.The positive expression rates of sinus endothelial cells and Kupfer cells in the high KGR group were significantly higher(sinus endothelial cells: P=0.01,Kupfer cells: P=0.028),indicating that the two kinds of cells are closely related to the speed of liver regeneration.In addition,CD133+ liver stem cells in the high KGR group were significantly higher than those in the low KGR group(P=0.011)at the ALPPS-Ⅱ stage,and there was no significant difference in other indicators between the high and low KGR groups(P>0.05).Conclusions:The liver regeneration of ALPPS is a process on the mainly proliferation of hepatocytes and the participation of various other cells.The early promotion of liver regeneration by ALPPS may be correlation to liver sinusoidal endothelial cells and Kupffer cells in the liver.The expression rate of CD133 positive cells may be correlation to liver regeneration,and high expression rate has better regeneration ability.