Improved liver function after portal vein embolization and an elective right hepatectomy

Abstract

Background: Portal vein embolization (PVE) is used before extensive hepatic resections to increase the volume of the future remnant liver within acceptable safety margins (conventionally >0.6% of the patient's weight). The objective was to determine whether pre-operative PVE impacts on post-operative liver function independently from the increase in liver volume.

Methods: The post-operative liver function of patients who underwent an anatomical right liver resection with (n = 28) and without (n = 53) PVE were retrospectively analysed. Donors of the right liver were also analysed (LD) (n = 17).

Results: Patient characteristics were similar, except for age, weight and American Society of Anesthesiologists (ASA) score that were lower in LD. Post-operative factor V and bilirubin levels were, respectively, higher and lower in patients with PVE compared with patients without PVE or LD (P < 0.05). Patients with PVE had an increased blood loss, blood transfusions and sinusoidal obstruction syndrome. The day-3 bilirubin level was 40% lower in the PVE group compared with the no-PVE group after adjustment for body weight, chemotherapy, operating time, Pringle time, blood transfusions, remnant liver volume, pre-operative bilirubin level and pre-operative prothrombin ratio (P = 0.001).

Conclusions: For equivalent volumes, the immediate post-operative hepatic function appears to be better in livers prepared with PVE than in unprepared livers. Future studies should analyse whether the conventional inferior volume limit that allows a safe liver resection may be lowered when a PVE is performed.

Figure 1

Post-operative serum factor V (a, prothrombin ratio (b), bilirubin (c), alanine transaminase (ALT) (d) and aspartate transaminase (AST) (e) levels for patients with portal vein embolization (PVE) (blue dots), without PVE (black triangles) and liver donors (LD) (red squares). The mean values are reported from day 0 (before the surgery, except for factor V) to post-operative day 10. Values are expressed as mean ± SD. * and † refers to a significant P value comparing PVE versus no PVE and PVE versus liver donors, respectively. P-values were calculated using the Mann–Whitney U-Test

Figure 2

(a) Post-operative liver function index (Bilirubin at day 3 × Patient's weight/Remnant Liver Volume). P-values were calculated using the Mann–Whitney U-Test. (b) Bilirubin levels at day 3 as a function of the Remnant Liver Volume to Body Weight ratios. (c) Kaplan–Meier estimates representing the time to bilirubin normalization (i.e. ≤25 μmol/l). P-values were calculated using the Gehan–Breslow–Wilcoxon Test. Patients are represented as follow: portal vein embolization (PVE) (blue dots), no portal vein embolization (PVE) (red squares) and liver donors (LD) (black triangles)