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During major resection of liver carcinoma, liver regeneration (LR) is induced by various clinical and biological factors. Heme oxygenase (HO)-1 has been found as a key inducer of LR in preclinical trial. The clinical evidence for the role of HO-1 in liver dysfunction (LD) including LR is still unknown and has been included in this study. Therefore, plasma HO-1 were monitored during perioperative period in 65 patients with hepatectomy, with 35 training and 30 validation cohorts. LD were evaluated by liver function serum markers and calculation of regeneration indices, respectively. In the training setting, HO-1 levels were remarkably reduced after liver resection (P &lt; 0.001) and gradually recovered within 7 days after surgery. Preoperative HO-1 specifically predicted LD during the first week after surgery (AUC: 0.757;  P  = 0.01). In patients with LD and complications after surgery, HO-1 levels decreased throughout the perioperative period. In addition, we had also confirmed that low levels of HO-1 (&lt;169 ng/ml) before surgery were associated with an increase in the incidence of postoperative LD and morbidity ( P  = 0.007,  P  = 0.045), and decrease of liver regeneration ( P  = 0.005). And HO-1 was an independent predictor for poor clinical outcome. We had provided the first clinical data verifying that human HO-1 was related to LD. Consequently, HO-1 levels can be used as effective clinical indicators to predict LD and clinical outcome, and can be used as intervention target before liver resection.

HO-1 Protects Remnant Liver against Dysfunction after Major Hepatectomy in Humans