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. 2016 Dec;89(1068):20160306.
doi: 10.1259/bjr.20160306. Epub 2016 Oct 12.

Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization-the effect of collaterals on embolized liver volume

Martin Zeile  1   2 , Artur Bakal  2 , Jan E Volkmer  1 , Gregor A Stavrou  2   3 , Philip Dautel  2   4 , Jan Hoeltje  1   2 , Axel Stang  2   5 , Karl J Oldhafer  2   3 , Roland Brüning  1   2
Affiliations

Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization-the effect of collaterals on embolized liver volume

Martin Zeile et al. Br J Radiol. 2016 Dec.

Abstract

Objective: The purpose of this retrospective study was to monitor hypertrophy of future liver remnant following portal vein embolization (PVE) before planned extended right hepatectomy. However, because individual responses to PVE are highly variable, our focus was to identify cofactors of successful hypertrophy.

Methods: 28 patients with primary or secondary liver tumours, mean age 64.1 ± 12.9 years, underwent PVE. Volumetric analysis of hypertrophy before and after PVE (median 39.0 ± 15.7 days) was performed. The embolized liver segments were investigated for occurrence of reperfusion of their portal branches. Blood parameters before PVE were additionally investigated.

Results: Patients were divided into responders (21/28) and non-responders (7/28) by post-PVE standardized future liver remnant being above or below 25%, respectively. No significant differences between the groups were found regarding biometric and volumetric parameters before PVE. In the entire group after PVE, the mean absolute increase of Segments 2 and 3 was 196.0 ± 84.7 cm3 and the median relative increase was 46.6 ± 98.8%. The formation of left to right hepatic portoportal collaterals exhibited a negative correlation to successful hypertrophy (p = 0.004) as well as low plasma total protein (p = 0.019). Successful embolization of Segment IV showed only a trend to significance (p = 0.098).

Conclusion: Cofactors associated with a favourable outcome regarding hypertrophy were the absence of collaterals in the control CT scans and high plasma total protein. Advances in knowledge: Portoportal collaterals negatively influence hypertrophy after PVE. On the other hand, plasma total protein is a positive prognostic indicator on hypertrophy of the liver in our cohort.

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Figures

Figure 1.
Figure 1.
Images of two patients which showed portal revascularization caused by portal collaterals (arrowheads) distally of the coils in the portal main branches (asterisks). (a, b) show the first patient and (c, d) show the second patient in transversal followed by coronal plane, respectively.
Figure 2.
Figure 2.
Images of a patient before (a) and after (b) PVE. The arrowhead in (a) marks an only marginally detectable portal side branch of the main right portal vein which was not detected during angiography. This vessel is depicted in (b) 5 weeks after PVE. The vessel diameter is largely increased and is functioning as a portal collateral which is suspected to impede hypertrophy of the FLR.
See this image and copyright information in PMC

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