Hemodynamic changes in ALPPS influence liver regeneration and function: results from a prospective study.

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Liver regeneration

Background:

• Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is a two-stage surgical procedure for extensive liver resections.
• Elevated portal flow and pressure post-hepatectomy can impair future liver remnant (FLR) growth, risking post-hepatectomy liver failure (PHLF).
• Understanding liver hemodynamics is crucial for optimizing FLR regeneration and function after staged hepatectomy.

Purpose of the Study:

• To prospectively evaluate the impact of liver hemodynamics on FLR regeneration and function in patients undergoing ALPPS.
• To identify hemodynamic parameters that predict successful FLR growth and function post-ALPPS stage-1.

Main Methods:

• Twenty-three patients undergoing ALPPS were prospectively studied.
• Liver hemodynamics, including portal vein pressure (PVP) and hepatic to portal vein gradients (HVPG), were assessed.
• FLR volume was measured by angio-CT, and function was evaluated using 99mTc-Mebrofenin-scintigraphy.

Main Results:

• End-of-stage-1 portal vein flow positively correlated with FLR volume increase (p=0.002).
• Patients with PVP < 20 mmHg and HVPG < 15 mmHg exhibited significantly higher FLR regeneration (76.7% vs. 30.6%, p=0.04) and function (26.7% vs. -0.13%, p=0.02).
• FLR regeneration was inversely correlated with baseline FLR/Total Liver Volume and FLR/Body Weight ratios.

Conclusions:

• Liver hemodynamic stress post-ALPPS stage-1 critically influences FLR volume and function.
• Optimal FLR regeneration and function are achieved with PVP < 20 mmHg and HVPG < 15 mmHg.
• Liver volume alone may overestimate function and be insufficient for precise stage-2 timing.