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. 2023 Jan 21;408(1):54.
doi: 10.1007/s00423-023-02784-w.

Influence of cholestasis on portal vein embolization-induced hypertrophy of the future liver remnant

Xinwei Chang #  1   2   3 , Remon Korenblik #  4   5 , Bram Olij  4   5 , Robrecht R M M Knapen  6 , Christiaan van der Leij  5   6 , Daniel Heise  7 , Marcel den Dulk  4   7 , Ulf P Neumann  4   7 , Frank G Schaap  8   7 , Ronald M van Dam  4   5   7 , Steven W M Olde Damink  4   8   7
Affiliations

Influence of cholestasis on portal vein embolization-induced hypertrophy of the future liver remnant

Xinwei Chang et al. Langenbecks Arch Surg. .

Abstract

Purpose: In the pre-clinical setting, hepatocellular bile salt accumulation impairs liver regeneration following partial hepatectomy. Here, we study the impact of cholestasis on portal vein embolization (PVE)-induced hypertrophy of the future liver remnant (FLR).

Methods: Patients were enrolled with perihilar cholangiocarcinoma (pCCA) or colorectal liver metastases (CRLM) undergoing PVE before a (extended) right hemihepatectomy. Volume of segments II/III was considered FLR and assessed on pre-embolization and post-embolization CT scans. The degree of hypertrophy (DH, percentual increase) and kinetic growth rate (KGR, percentage/week) were used to assess PVE-induced hypertrophy.

Results: A total of 50 patients (31 CRLM, 19 pCCA) were included. After PVE, the DH and KGR were similar in patients with CRLM and pCCA (5.2 [3.3-6.9] versus 5.7 [3.2-7.4] %, respectively, p = 0.960 for DH; 1.4 [0.9-2.5] versus 1.9 [1.0-2.4] %/week, respectively, p = 0.742 for KGR). Moreover, pCCA patients with or without hyperbilirubinemia had comparable DH (5.6 [3.0-7.5] versus 5.7 [2.4-7.0] %, respectively, p = 0.806) and KGR (1.7 [1.0-2.4] versus 1.9 [0.8-2.4] %/week, respectively, p = 1.000). For patients with pCCA, unilateral drainage in FLR induced a higher DH than bilateral drainage (6.7 [4.9-7.9] versus 2.7 [1.5-4.2] %, p = 0.012). C-reactive protein before PVE was negatively correlated with DH (ρ = - 0.539, p = 0.038) and KGR (ρ = - 0.532, p = 0.041) in patients with pCCA.

Conclusions: There was no influence of cholestasis on FLR hypertrophy in patients undergoing PVE. Bilateral drainage and inflammation appeared to be negatively associated with FLR hypertrophy. Further prospective studies with larger and more homogenous patient cohorts are desirable.

Keywords: Cholestasis; Colorectal liver metastases; Liver growth; Perihilar cholangiocarcinoma; Portal vein embolization.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Serum CRP negatively correlates with hypertrophy of FLR in patients with pCCA. Correlations between degree of hypertrophy of FLR and serum bilirubin levels before drainage (A) and before PVE (B). Correlations between serum CRP levels and degree of hypertrophy and kinetic growth rate of FLR in patients with pCCA (C and D, respectively) and CRLM (E and F, respectively). mFLR was used for assessing hypertrophy of FLR. Correlations were assessed using Spearman’s rank test. CRLM, colorectal liver metastasis; pCCA, perihilar cholangiocarcinoma; CRP, C-reactive protein
Fig. 2
Fig. 2
Degree of hypertrophy of the future liver remnant is higher in patients with unilateral biliary drainage. Seventeen out of nineteen patients with perihilar cholangiocarcinoma received biliary drainage for relief of cholestasis prior to portal vein embolization. The future liver remnant (FLR) was drained in patients receiving unilateral drainage (n = 11). mFLR was used to assess the degree of hypertrophy. Mann–Whitney U test was used to compare degree of hypertrophy of FLR between two groups. Asterisks indicate significance level: *p < 0.05
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