Increase of Portal Vein Pressure Gradient After Hepatectomy Predicts Post-operative Liver Dysfunction

Area of Science:

• Hepatobiliary Surgery
• Surgical Physiology
• Liver Transplantation

Background:

• Post-hepatectomy liver failure (PHLF) is a significant cause of mortality and morbidity following liver resection.
• The suitability of Child-Pugh A patients with varying degrees of cirrhosis for hepatectomy remains a subject of debate.
• Understanding intraoperative factors influencing PHLF is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the impact of portal venous pressure gradient (PVPG) variations during hepatectomy on the incidence of PHLF.
• To identify predictive markers for PHLF in Child-Pugh A patients undergoing liver resection.

Main Methods:

• PVPG was measured before and after liver resection in 60 Child-Pugh A patients.
• Receiver operating characteristic (ROC) curve analysis determined the optimal PVPG cutoff for PHLF prediction.
• Univariate and multivariable analyses identified independent risk factors for PHLF.

Main Results:

• The mean PVPG increased from 5.17 ± 4.78 mmHg to 6.37 ± 4.44 mmHg post-resection.
• An increment of 1.5 mmHg in PVPG was the optimal cutoff to predict PHLF.
• Prothrombin time (PT), PVPG increments ≥ 1.5 mmHg, and resection of ≥ 3 liver segments were independent predictors of PHLF.

Conclusions:

• An acute increase in PVPG after hepatectomy is associated with an elevated risk of PHLF in Child-Pugh A patients.
• Intraoperative PVPG monitoring can aid in risk stratification for PHLF.
• These findings may inform surgical decision-making and patient management.