Vasopressin and fluid retention after liver resection: Comparison with the renin-angiotensin-aldosterone system by surgical extent and liver function

Figure 1 Perioperative changes in plasma aldosterone concentration and arginine vasopressin in all patients. A and B: Temporal changes in plasma aldosterone concentration (PAC) (A) and arginine vasopressin (AVP) (B) levels in all 56 patients undergoing liver resection. Both PAC and AVP increased significantly immediately after liver resection, followed by gradual normalization on postoperative day 5. Values were expressed as medians with interquartile ranges. ^aP < 0.01 vs preoperative baseline. PAC: Plasma aldosterone concentration; AVP: Arginine vasopressin; LR: Liver resection; POD: Postoperative day.

Figure 2 Comparison of plasma aldosterone concentration and arginine vasopressin dynamics by liver function. A and B: Changes in plasma aldosterone concentration (PAC) (A) and arginine vasopressin (AVP) (B) in patients with normal liver (NL) (blue line) and impaired liver (IL) (red line), stratified by the indocyanine green retention rate at 15 minutes (< 10% = NL; ≥ 10% = IL). Both groups exhibited postoperative elevations in PAC and AVP with no significant intergroup differences at any time point. Values are expressed as medians with interquartile ranges. NL: Normal liver; IL: Impaired liver; PAC: Plasma aldosterone concentration; AVP: Arginine vasopressin; LR: Liver resection; POD: Postoperative day.

Figure 3 Comparison of plasma aldosterone concentration and arginine vasopressin dynamics by surgical extent. A and B: Changes in plasma aldosterone concentration (PAC) (A) and arginine vasopressin (AVP) (B) in major liver resection (MajLR) (orange line) and minor liver resection (MinLR) (green line) groups. PAC transiently increased immediately after liver resection in both groups, whereas AVP elevation persisted longer in MajLR cases. AVP levels on postoperative day 1 were significantly higher in MajLR than in MinLR. Values are expressed as medians with interquartile ranges. ^aP < 0.05. MinLR: Minor liver resection; MajLR: Major liver resection; PAC: Plasma aldosterone concentration; AVP: Arginine vasopressin; LR: Liver resection; POD: Postoperative day.

Figure 4 Incidence of hypervasopressinemia after liver resection according to surgical extent. The major liver resection (MajLR) group (orange bars) had a higher proportion of patients with plasma arginine vasopressin ≥ 4.0 pg/mL compared to the minor liver resection group (green bars). Hypervasopressinemia was significantly more frequent in the MajLR group on postoperative day (POD) 1 and 5. Although the early increase on POD 1 likely reflects intraoperative fluid-restrictive management and hemodynamic shifts inherent to major liver resection, the persistence to POD 5 despite postoperative rehydration suggests a prolonged neuroendocrine response proportional to surgical stress. ^aP < 0.05. MinLR: Minor liver resection; MajLR: Major liver resection; LR: Liver resection; POD: Postoperative day.