Post-hepatectomy liver failure after major hepatic surgery: not only size matters

Asenbaum, Ulrika; Kaczirek, Klaus; Ba‐Ssalamah, Ahmed; Ringl, Helmut; Schwarz, Christoph; Waneck, Fredrik; Fitschek, Fabian; Loewe, Christian; Nolz, Richard

doi:10.1007/s00330-018-5487-y

Cited by 55 publications

(32 citation statements)

References 37 publications

(42 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With the advent of the HIBA (Hospital Italiano de Buenos Aires) index11 (a technique of hepatobiliary scintigraphy using 99m Tc-mebrofenin that our group described), the uncertainty in the estimation of the FLR seems to be reduced. The paradigm has changed for us from the indirect estimation of the liver function through the FLR volume and its proportion with the patient’s weight toward the calculation of the true functionality of the FLR through its radionuclide excretion potential.…”

Section: Discussionmentioning

confidence: 99%

Preoperative portal vein embolization followed by right hepatectomy to treat a complex common bile duct injury in a 5-year-old child

Glinka

Bruballa

Santibañes

et al. 2019

World Jnl Ped Surgery

View full text Add to dashboard Cite

BackgroundCommon bile duct injuries (CBDIs) remains a rare but serious complication in children undergoing laparoscopic cholecystectomy (LC), with an incidence of 0.44%. In severe lesions, a major liver resection may be necessary as a definitive treatment. The current principles for safe hepatectomy are mainly focused on the liver parenchyma that remains after resection. Therefore, one of the main factors related to posthepatectomy hepatic insufficiency is the quantity and quality of the future liver remnant (FLR). To achieve an optimal FLR, techniques such as portal vein embolization (PVE) are available.Case presentationWe present the case of a 5-year-old child with a severe CBDI after LC, treated with preoperative PVE followed by a right hepatectomy as definitive treatment. No reports of liver resections and PVE are described in the literature concerning the pediatric population.

show abstract

Section: Discussionmentioning

confidence: 99%

Preoperative portal vein embolization followed by right hepatectomy to treat a complex common bile duct injury in a 5-year-old child

Glinka

Bruballa

Santibañes

et al. 2019

World Jnl Ped Surgery

View full text Add to dashboard Cite

show abstract

“…Asenbaum et al recently published a study showing that a measure derived using RE was significantly better than only using liver volumes [136]. There are also a number of other similar studies.…”

Section: Liver Surgerymentioning

confidence: 94%

Non-Invasive Characterization of Liver Disease : By Multimodal Quantitative Magnetic Resonance

Karlsson

2020

Linköping University Medical Dissertations

View full text Add to dashboard Cite

There is a large and unmet need for diagnostic tool that can be used to characterize chronic liver diseases (CLD). In the earlier stages of CLD, much of the diagnostics involves performing biopsies, which are evaluated by a histopathologist for the presence of e.g. fat, iron, inflammation, and fibrosis. Performing biopsies, however, have two downsides: i) biopsies are invasive and carries a small but non-negligible risk for serious complications, ii) biopsies only represents a tiny portion of the liver and are thus prone to sampling error. Moreover, in the later stages of CLD, when the disease has progressed far enough, the ability of the liver to perform its basic function will be compromised. In this stage, there is a need for better methods for accurately measuring liver function. Additionally, measures of liver function can also be used when developing new drugs, as biomarkers for drug-induced liver injury (DILI), which is a serious drug-safety issue. Magnetic resonance imaging (MRI) is a non-invasive medical imaging modality, which have shown much promise with regards to characterizing liver disease in all of the above-mentioned aspects. The aim of this PhD project was to develop and validate MR-based methods that can be used to non-invasively characterize liver disease. Paper I investigated if R2* mapping, a MR-method for measuring liver iron content, can be confounded by liver fat. The results show fat does affect R2*. The conclusion was therefore that fat must be taken into account when measuring small amounts of liver iron, as a small increase in R2* could be due to either small amounts of iron or large amounts of fat. Paper II examined whether T1 mapping, which is another MR-method, can be used for staging liver fibrosis. The results of previous research have been mixed; some studies have been very promising, whereas other studies have been less promising. Unfortunately, the results in Paper II belongs to the less promising studies. Paper III focused on measuring liver function by dynamic contrast-enhanced MRI (DCE-MRI) using a liver specific contrast agent, which is taken up the hepatocytes and excreted to the bile. The purpose of the paper was to extend and validate a method for estimating uptake and efflux rates of the contrast agent. The method had previously only been applied in health volunteers. Paper II showed that the method can be applied to CLD patients and that the uptake of the contrast agent is lower in patients with advanced fibrosis.

show abstract

“…In a retrospective study, our group [74] looked at how well functional future liver remnant (functFLR), as calculated from the RLE on GA-MRI and volumetry on multidetector computed tomography (MDCT) done within 10 weeks of a planned major resection, predicted post-hepatectomy liver failure (PHLF) following major liver resection compared to well-established clinical tests. In a multivariate analysis, we found that a decreased functFLR was independently associated with the probability of PHLF (0.561; P = 0.002).…”

Section: Preoperative Evaluation Of Remnant Liver Functionmentioning

confidence: 99%

Quantification of liver function using gadoxetic acid-enhanced MRI

et al. 2020

Self Cite

View full text Add to dashboard Cite

The introduction of hepatobiliary contrast agents, most notably gadoxetic acid (GA), has expanded the role of MRI, allowing not only a morphologic but also a functional evaluation of the hepatobiliary system. The mechanism of uptake and excretion of gadoxetic acid via transporters, such as organic anion transporting polypeptides (OATP1,3), multidrug resistance-associated protein 2 (MRP2) and MRP3, has been elucidated in the literature. Furthermore, GA uptake can be estimated on either static images or on dynamic imaging, for example, the hepatic extraction fraction (HEF) and liver perfusion. GA-enhanced MRI has achieved an important role in evaluating morphology and function in chronic liver diseases (CLD), allowing to distinguish between the two subgroups of nonalcoholic fatty liver diseases (NAFLD), simple steatosis and nonalcoholic steatohepatitis (NASH), and help to stage fibrosis and cirrhosis, predict liver transplant graft survival, and preoperatively evaluate the risk of liver failure if major resection is planned. Finally, because of its noninvasive nature, GA-enhanced MRI can be used for long-term follow-up and post-treatment monitoring. This review article aims to describe the current role of GA-enhanced MRI in quantifying liver function in a variety of hepatobiliary disorders.

show abstract

Post-hepatectomy liver failure after major hepatic surgery: not only size matters

Cited by 55 publications

References 37 publications

Preoperative portal vein embolization followed by right hepatectomy to treat a complex common bile duct injury in a 5-year-old child

Preoperative portal vein embolization followed by right hepatectomy to treat a complex common bile duct injury in a 5-year-old child

Non-Invasive Characterization of Liver Disease : By Multimodal Quantitative Magnetic Resonance

Quantification of liver function using gadoxetic acid-enhanced MRI

Contact Info

Product

Resources

About