Liver kinetic growth rate predicts postoperative liver failure after ALPPS

Kambakamba, Patryk; Stocker, Daniel; Reiner, Cäcilia S.; Nguyen-Kim, Thi Dan Linh; Linecker, Michael; Eshmuminov, Dilmurodjon; Petrowsky, Henrik; Clavien, Pierre‐Alain; Lesurtel, Mickaël

doi:10.1016/j.hpb.2016.07.005

Cited by 31 publications

(33 citation statements)

References 28 publications

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“…Kinetic growth rate following PVE, defined as the increase in FLR volume from baseline to first post‐PVE volume assessment divided by length of time between PVE and first post‐PVE volumetry, has been shown to be a better predictor of postoperative morbidity and mortality after liver resection . It has also been shown as a useful tool in estimating the risk of postoperative liver failure after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) . However, these studies mainly included patients undergoing major hepatectomy without EBR for colorectal liver metastases or hepatocellular carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…One of the major causes of liver failure after hepatectomy could be insufficient remnant liver regeneration . It has been shown that the kinetic growth rate (KGR), defined as the degree of regeneration at initial volume assessment divided by the term after PVE, can accurately predict postoperative morbidity and mortality . However, the usefulness of KGR in the early phase following hepatectomy for predicting morbidity and mortality in patients undergoing extended hepatectomy with EBR has never been investigated.…”

Section: Introductionmentioning

confidence: 99%

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Discrepancy between volume and functional recovery in early phase liver regeneration following extended hepatectomy with extrahepatic bile duct resection

Maeda

Yokoyama

Igami

et al. 2019

Hepatology Research

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Aim To elucidate the clinical factors having an impact on liver regeneration rate following preoperative portal vein embolization (PVE) and subsequent extended hepatectomy. The correlation between liver volume and functional recovery after extended hepatectomy was also investigated. Methods Records of patients who underwent extended hepatectomy with extrahepatic bile duct resection following PVE for perihilar cholangiocarcinoma were reviewed retrospectively with attention to liver regeneration. All patients underwent computed tomography before PVE, after PVE (immediately before surgery), and on postoperative day (POD) 7. The kinetic growth rate (KGR) was calculated as the percent increase in liver volume relative to the future liver remnant volume per day after PVE (KGRPVE) and after POD 7 (KGRPOD7) using the computed tomography images before PVE, after PVE, and on POD 7. Results In the 289 study patients, the median of KGRPVE was 1.35%/day whereas that of KGRPOD7 was 5.56%/day. The extent of liver resection had the greatest impact on both KGRPVE and KGRPOD7 and the impacts of other factors were less. There was a significant negative correlation between KGRPVE and KGRPOD7 (P = 0.002). No correlations were observed between KGRPVE or KGRPOD7 and serum total bilirubin and prothrombin time – international normalized ratio on POD 7, nor in the incidence of liver failure after surgery. Conclusions Early phase liver regeneration after extended hepatectomy was largely influenced by the extent of liver resection and showed no correlation with the indices of liver failure. There was a discrepancy between volume and functional recovery in early phase liver regeneration.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Discrepancy between volume and functional recovery in early phase liver regeneration following extended hepatectomy with extrahepatic bile duct resection

Maeda

Yokoyama

Igami

et al. 2019

Hepatology Research

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“…Meticulous reports on liver failure criteria should therefore be encouraged for any future reports on ALPPS outcomes. It is interesting to note that liver failure by ISGLS criteria in published series is only 8.3% [20] or 15% [30] in the 2 series in which HBS was performed to guide clinical management, and 36% in a series [16] in which no HBS was used. It suggests that clinical management with HBS may be able to avoid liver failure after ALPPS.…”

Section: Discussionmentioning

confidence: 99%

“…A correlation between FLR volume and complications did not exist. Next to MELD score or ISGLS criteria after stage 1, kinetic growth rate of the FLR [16] and a dedicated ALPPS futility score [17] have been proposed to assess the risk of stage-2 resection. Table 2 lists the 5 studies investigating interstage liver function assessment.…”

Section: Incidence Of Liver Failure and Higher Complications After Alppsmentioning

confidence: 99%

“…One study showed ICG-R15 decreased from 9.9 to 7% between stages but increased to 33% after stage 2 [21]. Another study showed an increase from 3.6 to 5.4% postoperatively [16]. LiMAx (maximum liver function capacity) is another global liver function test based on hepatic enzyme metabolism, which is quantified using a breath test after i.v.…”

Section: Incidence Of Liver Failure and Higher Complications After Alppsmentioning

confidence: 99%

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Hypertrophy and Liver Function in ALPPS: Correlation with Morbidity and Mortality

Kang¹,

Schadde²

2017

Visc Med

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Background: ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was introduced with the promise to reduce posthepatectomy liver failure (PHLF) in extended hepatectomies but has higher morbidity and mortality rates compared to conventional methods of volume enhancement. There are few studies of the incidence of PHLF after ALPPS and little information on how to avoid PHLF by functional testing. It remains unclear what causes the compromise in liver function despite rapid volume gain and if any of the modifications proposed reduce the incidence of PHLF. This review summarizes published data on this topic. Methods: This is a systematic review that studies literature on the incidence of liver failure and assessment of liver function following ALPPS as well as modifications of the existing technique. Articles were searched in PubMed, evaluated, selected, and tabulated. Results: The literature search revealed 326 articles that met the selection criteria. PHLF criteria as defined by the International Study Group of Liver Surgery (ISGLS) were the most commonly used criteria, but PHLF was frequently not defined. PHLF occurred most frequently after stage 2 of ALPPS at around 30% in most larger studies. Hepatobiliary scintigraphy showed a discrepancy between volume and functional growth of the liver. Function increase was only 50% compared to volume increase. Mechanistic explanations using histologic analyses have been given to explain the immaturity of the liver after rapid hypertrophy. Modifications of ALPPS showed a comparable volumetric gain when compared to classic ALPPS, but data were lacking to assess PHLF. Conclusion: ALPPS has relatively high rates of PHLF, morbidity, and mortality. This may be explained by data demonstrating functional growth when compared to volume growth. ALPPS should not be performed without functional assessment and with caution.

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Post-operative Liver Failure and Pre-operative Evaluation of the Risk of Surgery in Patients with Liver Disease

Tomassini

Mariani

Aseni³

et al. 2023

The High-Risk Surgical Patient

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Liver kinetic growth rate predicts postoperative liver failure after ALPPS

Abstract: Assessment of KGR is a novel tool to estimate the risk of PHLF after ALPPS. Respecting KGR and sFLR after ALPPS stage 1 may increase safety in patients undergoing ALPPS.

Cited by 31 publications

References 28 publications

Discrepancy between volume and functional recovery in early phase liver regeneration following extended hepatectomy with extrahepatic bile duct resection

Discrepancy between volume and functional recovery in early phase liver regeneration following extended hepatectomy with extrahepatic bile duct resection

Hypertrophy and Liver Function in ALPPS: Correlation with Morbidity and Mortality

Post-operative Liver Failure and Pre-operative Evaluation of the Risk of Surgery in Patients with Liver Disease

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