99mTc-GSA scintigraphy and modified albumin–bilirubin score can be complementary to ICG for predicting posthepatectomy liver failure

Abstract

Background: Posthepatectomy liver failure (PHLF) remains a severe complication after liver resection. This retrospective study investigated the correlation of three hepatic functional tests and whether 99mTc-galactosyl human serum albumin (99mTc-GSA) scintigraphy and modified albumin–bilirubin (ALBI) score are useful for predicting PHLF. Methods: A total of 413 consecutivepatients undergoing hepatectomies between January 2017 and December 2020 at our institution were enrolled in this retrospective cohort study. To evaluate preoperative hepatic functional reserve, modified ALBI grade, indocyanine green clearance (ICG-R15), and 99mTc-GSA scintigraphy (LHL15) were routinely examined before the scheduled hepatectomy. Based on the retrospective chart review, multivariate logistic regression analysis adjusted for confounding factors was performed to confirm that ALBI, ICG-R15, and LHL15 are independent risk factors for PHLF. Results: ICG-R15 and LHL15 were moderately correlated (r = −0.61). However, the correlation with LHL15 weakened when ICG-R15 was about ³20. Weak correlations were observed between LHL15 and ALBI score (r = −0.269) and ALBI score and ICG-R15 (r = 0.339). Of 413 patients, 66 (19%) developed PHLF (grade A: n = 20, grade B: n = 44, grade C: n = 2). Multivariable logistic regression analyses, mALBI grade (P= .014) and ICG-R15 (P < .001) were significant independent risk factors for PHLF. Subgroup analysis showed that ICG-R15 <19, major hepatectomy, and mALBI grade and ICG-R15 ³19, major hepatectomy, and LHL15 were significant independent risk factors for PHLF (P =.036,.020,.043, and.013, respectively). Conclusion: LHL15 and mALBI grade would be complementary to ICG-R15 for predicting PHLF risk.