Leberreserve

Leberreserve, often referred to in English as hepatic functional reserve, is the liver’s capacity to sustain normal metabolic and synthetic functions in the presence of injury or reduced parenchymal mass. It depends on the amount of functioning hepatocytes, biliary excretion, hepatic blood flow, and the liver’s regenerative potential. In a healthy liver, the reserve is large enough to accommodate additional workload and minor injuries.

In liver disease, the reserve declines as hepatocyte loss, fibrosis, and architectural disruption reduce metabolic capacity. Cirrhosis, steatosis, and active inflammation can impair function, and altered hepatic perfusion or portal hypertension can further limit reserve. Regenerative capacity and the distribution of remaining function across liver tissue also influence the effective reserve.

Clinically, hepatic functional reserve informs risk in liver-directed procedures and transplantation. It is assessed with a combination of functional tests and imaging. Common measures include indocyanine green clearance (ICG-PDR) and indocyanine green retention at 15 minutes (ICG-R15), galactose elimination capacity, and hepatobiliary scintigraphy or MRI-based functional imaging to estimate the future liver remnant’s function.

Because no single test fully defines Leberreserve, results are integrated with clinical evaluation and disease severity scores, such as Child-Pugh or MELD, to guide decision-making on interventions and transplant eligibility. Related concepts include hepatic regeneration and overall liver function assessment.