Aoki Y, Kawano Y, Ga R, Endo K, Ueda J, Shimizu T, Yoshida H. Vasopressin and fluid retention after liver resection: Comparison with the renin-angiotensin-aldosterone system by surgical extent and liver function. World J Gastroenterol 2026; 32(10): 115167 [DOI: 10.3748/wjg.v32.i10.115167]
Corresponding Author of This Article
Youichi Kawano, MD, Associate Professor, Department of Gastroenterological Surgery, Nippon Medical School, 1-1-5 Sendagi, Tokyo 113-8603, Japan. y-kawano@nms.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mar 14, 2026 (publication date) through Mar 2, 2026
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Journal Information of This Article
Publication Name
World Journal of Gastroenterology
ISSN
1007-9327
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Aoki Y, Kawano Y, Ga R, Endo K, Ueda J, Shimizu T, Yoshida H. Vasopressin and fluid retention after liver resection: Comparison with the renin-angiotensin-aldosterone system by surgical extent and liver function. World J Gastroenterol 2026; 32(10): 115167 [DOI: 10.3748/wjg.v32.i10.115167]
Yuto Aoki, Ryo Ga, Department of Gastroenterological Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai 270-1694, Chiba, Japan
Youichi Kawano, Kazuhiko Endo, Junji Ueda, Tetsuya Shimizu, Hiroshi Yoshida, Department of Gastroenterological Surgery, Nippon Medical School, Tokyo 113-8603, Japan
Author contributions: Aoki Y conceived and designed the study, obtained informed consent, collected and analyzed the data, and drafted the manuscript; Kawano Y supervised the study, provided methodological advice, and contributed to manuscript revision; Yoshida H served as the principal investigator and had overall responsibility for the study; Endo K, Ga R, Ueda J, Shimizu T assisted with data collection and chart review and provided critical comments on the manuscript.
Supported by the Designated Scholarship Donations from Otsuka Pharmaceutical Co., Ltd. to the Authors’ Institution (2018-2019).
Institutional review board statement: The study protocol was approved by the Ethics Committee of Nippon Medical School Hospital (Approval No. 30-01-1070).
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: Statistical codes and de-identified datasets are available from the corresponding author upon request.
Corresponding author: Youichi Kawano, MD, Associate Professor, Department of Gastroenterological Surgery, Nippon Medical School, 1-1-5 Sendagi, Tokyo 113-8603, Japan. y-kawano@nms.ac.jp
Received: October 14, 2025 Revised: December 5, 2025 Accepted: January 16, 2026 Published online: March 14, 2026 Processing time: 143 Days and 23.3 Hours
Abstract
BACKGROUND
Early postoperative edema and ascites after liver resection are common; however, the endocrine drivers of water retention are not fully defined. Arginine vasopressin (AVP) promotes antidiuresis via V2-mediated aquaporin trafficking, whereas the renin-angiotensin-aldosterone system primarily modulates sodium handling. Differences in postoperative trajectories and their relationship to early fluid retention have not been clarified in patients undergoing liver resection.
AIM
To examine postoperative changes in plasma AVP and plasma aldosterone concentration (PAC) after liver resection, and association with fluid retention.
METHODS
We conducted a prospective cohort study of adults undergoing elective liver resection at a tertiary center. Blood samples were collected preoperatively, immediately post-resection, and on postoperative days (POD) 1, 2, 3, and 5. The primary objective was characterizing postoperative dynamics of AVP and PAC. Secondary objectives evaluated their temporal alignment with early fluid retention (body weight, urine output during POD 1-3) and compared hormonal profiles between major and minor resections. Analyses used trajectory and time-based comparisons by resection extent.
RESULTS
AVP increased sharply immediately after resection and remained above the preoperative baseline through POD 3, showing the most pronounced and sustained elevation after major liver resection. In contrast, PAC showed a transient postoperative increase that returned to near-baseline levels by POD 2. The period of elevated AVP closely matched the time frame during which early postoperative fluid retention was most evident, as indicated by greater short-term weight gain and reduced urine output. These patterns were consistent across sensitivity analyses and showed similar directional trends in subgroup comparisons based on resection extent.
CONCLUSION
AVP remains elevated longer than aldosterone and coincides with early fluid retention, particularly after major resection. Vasopressin-driven antidiuresis may be important in postoperative water retention.
Core Tip: This study prospectively assessed postoperative changes in arginine vasopressin (AVP) and plasma aldosterone concentration (PAC) after liver resection and found that AVP elevation persisted longer than PAC elevation, particularly after major resections. The duration of elevated AVP closely matched the period of early postoperative fluid retention, highlighting the important role of AVP beyond the renin-angiotensin-aldosterone system. These findings suggest that targeting the V2 signaling pathway may offer strategies for optimizing fluid management and reducing complications in high-risk patients undergoing liver resection. A detailed understanding of postoperative hormonal changes is crucial for future clinical trials and therapeutic decisions.
