Ischaemia–reperfusion injury with Pringle's maneuver induces unusually large von Willebrand factor multimers after hepatectomy

AbstractIntroductionvon 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 methodsThirty-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. ResultsPlasma 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