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. 2017 Dec 7:25:6-11.
doi: 10.1016/j.amsu.2017.12.003. eCollection 2018 Jan.

Impact of liver volume and liver function on posthepatectomy liver failure after portal vein embolization- A multivariable cohort analysis

Patrick H Alizai  1 , Annabel Haelsig  1 , Philipp Bruners  2 , Florian Ulmer  1 , Christian D Klink  1 , Cornelis H C Dejong  3 , Ulf P Neumann  1   3 , Maximilian Schmeding  1   4
Affiliations

Impact of liver volume and liver function on posthepatectomy liver failure after portal vein embolization- A multivariable cohort analysis

Patrick H Alizai et al. Ann Med Surg (Lond). .

Abstract

Background: Liver failure remains a life-threatening complication after liver resection, and is difficult to predict preoperatively. This retrospective cohort study evaluated different preoperative factors in regard to their impact on posthepatectomy liver failure (PHLF) after extended liver resection and previous portal vein embolization (PVE).

Methods: Patient characteristics, liver function and liver volumes of patients undergoing PVE and subsequent liver resection were analyzed. Liver function was determined by the LiMAx test (enzymatic capacity of cytochrome P450 1A2). Factors associated with the primary end point PHLF (according to ISGLS definition) were identified through multivariable analysis. Secondary end points were 30-day mortality and morbidity.

Results: 95 patients received PVE, of which 64 patients underwent major liver resection. PHLF occurred in 7 patients (11%). Calculated postoperative liver function was significantly lower in patients with PHLF than in patients without PHLF (67 vs. 109 μg/kg/h; p = 0.01). Other factors associated with PHLF by univariable analysis were age, future liver remnant, MELD score, ASA score, renal insufficiency and heart insufficiency. By multivariable analysis, future liver remnant was the only factor significantly associated with PHLF (p = 0.03). Mortality and morbidity rates were 4.7% and 29.7% respectively.

Conclusion: Future liver remnant is the only preoperative factor with a significant impact on PHLF. Assessment of preoperative liver function may additionally help identify patients at risk for PHLF.

Keywords: Future liver remnant; LiMAx test; Liver function; Liver resection; Portal vein embolization; Posthepatectomy liver failure.

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