Posthepatectomy Portal Vein Pressure Predicts Liver Failure and Mortality after Major Liver Resection on Noncirrhotic Liver

Allard, Marc‐Antoine; Adam, René; Bucur, Pétru-Octav; Termos, Salah; Cunha, Antonio Sa; Bismuth, H; Castaing, Denis; Vibert, Éric

doi:10.1097/sla.0b013e3182a64b38

Cited by 119 publications

(105 citation statements)

References 51 publications

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“…Recently, intraoperative blood transfusion was identified as an independent predictor of posthepatectomy liver failure (Table 4) [41,43]. In line with these data, the present study showed that intraoperative packed red blood cell transfusion was identified as another determinant of the risk of PHLF.…”

Section: Discussionsupporting

confidence: 88%

Liver failure after hepatocellular carcinoma surgery

Motoyama

Kobayashi

Yokoyama

et al. 2014

Langenbecks Arch Surg

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Section: Discussionsupporting

confidence: 88%

Liver failure after hepatocellular carcinoma surgery

Motoyama

Kobayashi

Yokoyama

et al. 2014

Langenbecks Arch Surg

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“…Second, growth factors are crucial for liver regeneration after hepatectomy,30 and MARS might contribute to improved regeneration through an increase in plasma hepatocyte growth factor as found by Donati et al10 in selected patients with ALF and ACLF. Third, portal hypertension has been described as a major risk factor for the development of PHLF,36 and MARS treatment has been shown to reduce portal pressure in ACLF patients 9. However, all these potentially beneficial effects need further investigation in PHLF.…”

Section: Discussionmentioning

confidence: 99%

The molecular adsorbent recirculating system in posthepatectomy liver failure: Results from a prospective phase I study

Gilg

Sparrelid

Saraste³

et al. 2018

Hepatology Communications

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Posthepatectomy liver failure (PHLF) represents the single most important cause of postoperative mortality after major liver resection, yet no effective treatment option is available. Extracorporeal liver support devices might be helpful, but systematic studies are lacking. Accordingly, we aimed to assess the safety and feasibility of the Molecular Adsorbent Recirculating System (MARS) in patients with PHLF. Between December 2012 and May 2015, a total of 206 patients underwent major or extended hepatectomy, and 10 consecutive patients with PHLF (according to the Balzan 50:50 criteria) were enrolled into the study. MARS treatment was initiated on postoperative day 5‐7, and five to seven consecutive treatment sessions were completed for each patient. In total, 59 MARS cycles were implemented, and MARS was initiated and completed without major complications in any patient. However, 1 patient developed an immense asymptomatic hyperbilirubinemia (without encephalopathy), 1 had repeated clotting problems in the MARS filter, and 2 patients experienced access problems with the central venous line. Otherwise, no adverse events were observed. In 9 patients, the bilirubin level and international normalized ratio decreased significantly (P < 0.05) during MARS treatment. The 60‐ and 90‐day mortality was 0% and 10%, respectively. Among the 9 survivors, 4 still had liver dysfunction at 90 days postoperatively. Five patients were alive 1 year postoperatively without any signs of liver dysfunction or disease recurrence. Conclusion: The use of MARS in PHLF is feasible and safe and improves liver function in patients with PHLF. In the present study, 60‐ and 90‐day mortality rates were unexpectedly low compared to a historical control group. The impact of MARS treatment on mortality in PHLF should be further evaluated in a randomized controlled clinical trial. (Hepatology Communications 2018;2:445‐454)

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“…In an oncological context, some experimental studies have showed how low PVP after surgery is a protective factor against histological damage, leading to a better functional regeneration of liver [12][13][14]. Recently, Allard MA and colleagues [15] observed a significantly higher post-hepatectomy PVP in patients who develop posthepatectomy liver failure (all definitions considered) compared to those who did not. He suggested an intra-operative PVP cut off of 22mmHg, that is associated with 18.4%-21.1% (depending on definitions considered) of likelihood to develop a Small for flow liver failure, and a 90-days mortality of 12.7%.…”

Section: Volume 3 Issue 2 -2017mentioning

confidence: 96%

“Small-For-Flow” Liver Failure after Extended Hepatectomy: A Call for Update

Famularo¹

2017

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Emond et al. [1] first described, in 1996, a new syndrome occurring in small grafts in transplantation field, named small for Size Syndrome. After surgery, patients with a small grafts were affected by unpredictable elevation of bilirubin (not linked with surgical procedures), coagulopathy, prolonged cholestasis, portal hypertension and, if severe, ascites. The continuing liver dysfunction predisposes to further complications, including sepsis and gastrointestinal bleedings, leading to a clear liver failure. In the meantime, in liver resection field, the same syndrome was noticed after major hepatectomy (>3 segments resected), and it was named Post-Hepatectomy Liver Failure. With improvement of knowledge, nowadays we know that SFSS and PHLF are two side of the same coin. Different strategies, more in transplantation context, have been described to prevent and to treat the syndrome, but lack of data regarding the resection context is still a matter. In fact, where in transplant, pathophysiological studies and randomized clinical trial have been published to evaluate the etiology and the efficacy of procedures proposed, in resection field we are just translate transplantation experience, without a whole consensus between physician on how to predict, to diagnose, and to treat this post-hepatectomy liver failure. Diagnostic criteria, treatments, and pathophysiology are still unclear, with different opinion between physicians, and also disaccording if small for size and post-hepatectomy liver failures are really the same. Our opinion a part, we think it's time to start to analyze in deep this syndrome that account for more than 60% of death after major liver resections.

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Posthepatectomy Portal Vein Pressure Predicts Liver Failure and Mortality after Major Liver Resection on Noncirrhotic Liver

Abstract: Posthepatectomy PVP is an independent predictive factor of PLF and of 90-day mortality after major liver resection in patients without cirrhosis. Intraoperative modulation of PVP would be advisable when PVP exceeds 20 mm Hg.

Cited by 119 publications

References 51 publications

Liver failure after hepatocellular carcinoma surgery

Liver failure after hepatocellular carcinoma surgery

The molecular adsorbent recirculating system in posthepatectomy liver failure: Results from a prospective phase I study

“Small-For-Flow” Liver Failure after Extended Hepatectomy: A Call for Update

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