BACKGROUND: Excessive increase of portal flow and pressure following extended hepatectomy have been associated to insufficient growth or function of the future liver remnant (FLR), with the risk of post-hepatectomy liver failure (PHLF). We prospectively assess the influence of liver hemodynamics on FLR regeneration and function in Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS). METHODS: Twenty-three patients underwent ALPPS; liver hemodynamics were assessed throughout the procedures. Volume and function of the FLR were evaluated by angio-CT and 99mTc-Mebrofenin-scintigraphy. RESULTS: The portal vein flow at the end of stage-1 correlated with the increase of the FLR volume (p = 0.002). Patients with portal vein pressure (PVP) < 20 mmHg and hepatic to portal vein gradients (HVPG) < 15 mmHg at the end of ALPPS-1 showed higher FLR regeneration (76.7% vs. 30.6%, p = 0.04) and function (26.7% vs. -0.13%, p = 0.02). FLR regeneration was inversely correlated with baseline FLR/Total Liver Volume (p = 0.002) and FLR/Body Weight (p = 0.02). No correlation was found between volumes and function (p = 0.13). CONCLUSION: Liver hemodynamic stress at the end of ALPPS-1 influences the increase of the FLR volume and function, which is higher with PVP < 20 and HVPG < 15 mmHg. Liver volume overestimates liver function and could be imprecise to set stage-2 timing.

Hemodynamic changes in ALPPS influence liver regeneration and function: results from a prospective study / Tomassini, Federico; D'Asseler, Yves; Giglio, Mariano C; Lecluyse, Clarisse; Lambert, Bieke; Sainz-Barriga, Mauricio; Van Dorpe, Jo; Hoorens, Anne; Geboes, Karen; Troisi, Roberto I. - In: HPB. - ISSN 1365-182X. - 21:5(2019), pp. 557-565-565. [10.1016/j.hpb.2018.09.005]

Hemodynamic changes in ALPPS influence liver regeneration and function: results from a prospective study

Giglio, Mariano C
Formal Analysis
;
Troisi, Roberto I
Conceptualization
2019

Abstract

BACKGROUND: Excessive increase of portal flow and pressure following extended hepatectomy have been associated to insufficient growth or function of the future liver remnant (FLR), with the risk of post-hepatectomy liver failure (PHLF). We prospectively assess the influence of liver hemodynamics on FLR regeneration and function in Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS). METHODS: Twenty-three patients underwent ALPPS; liver hemodynamics were assessed throughout the procedures. Volume and function of the FLR were evaluated by angio-CT and 99mTc-Mebrofenin-scintigraphy. RESULTS: The portal vein flow at the end of stage-1 correlated with the increase of the FLR volume (p = 0.002). Patients with portal vein pressure (PVP) < 20 mmHg and hepatic to portal vein gradients (HVPG) < 15 mmHg at the end of ALPPS-1 showed higher FLR regeneration (76.7% vs. 30.6%, p = 0.04) and function (26.7% vs. -0.13%, p = 0.02). FLR regeneration was inversely correlated with baseline FLR/Total Liver Volume (p = 0.002) and FLR/Body Weight (p = 0.02). No correlation was found between volumes and function (p = 0.13). CONCLUSION: Liver hemodynamic stress at the end of ALPPS-1 influences the increase of the FLR volume and function, which is higher with PVP < 20 and HVPG < 15 mmHg. Liver volume overestimates liver function and could be imprecise to set stage-2 timing.
2019
HPB
Hemodynamic changes in ALPPS influence liver regeneration and function: results from a prospective study / Tomassini, Federico; D'Asseler, Yves; Giglio, Mariano C; Lecluyse, Clarisse; Lambert, Bieke; Sainz-Barriga, Mauricio; Van Dorpe, Jo; Hoorens, Anne; Geboes, Karen; Troisi, Roberto I. - In: HPB. - ISSN 1365-182X. - 21:5(2019), pp. 557-565-565. [10.1016/j.hpb.2018.09.005]
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/755502
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 24
  • ???jsp.display-item.citation.isi??? 21
social impact