Postoperative liver fibrosis: morphopathogenetic bases and diagnostic methods

Liver diseases remain an important global health problem. Postoperative liver fibrosis develops in 35-45% of patients after its resection or transplantation, as well as after laparoscopic interventions. The aim of the study is to identify the main cellular mechanisms of development and determine optimal diagnostic methods for postoperative liver fibrosis. Materials and methods. A literature review was conducted using the electronic databases PubMed, Google Scholar, Scopus, and elibrary. The work includes original research, systematic reviews and meta-analyses, 51 of the initially identified 117 sources. Results. Modern instrumental diagnostic methods make it possible to effectively determine the presence of existing fibrosis, respectively, their use is justified only in the IV phase of fibrogenesis. The possibility of using biochemical markers in the I-III phases of fibrogenesis is associated with traumatic damage and death of hepatocytes, as well as their apoptosis. And the use of direct biochemical markers in the III-IV phases of fibrogenesis is justified by the active synthesis and stabilization of the extracellular matrix, crosslinking of collagen fibers and their retraction. It should be noted that the biochemical markers M2BPGi and sTREM2 can effectively stratify patients according to the risk of complications in the postoperative period, and the use of FIB-4 and sTREM2 can significantly improve the preoperative assessment of the risk of liver failure. Conclusion. The most reliable diagnostic method is morphological analysis, which allows not only to identify the presence of fibrous changes in liver tissue and accurately determine the phase of fibrogenesis, but also to predict the progressive development of fibrosis in the postoperative period. Thus, knowledge of the morphopathogenetic foundations of the formation of postoperative liver fibrosis can not only provide early diagnosis, but will also allow the development of prevention and treatment measures based on the impact on the key links of fibrogenesis.