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Updated: Jun 27, 2025
Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure
Published on: September 13, 2014
Does depressurization of the portal vein before liver transplantation affect the recurrence of HCC? A nested
Guo Wei1, Yong Zhao1, Shifeng Feng1
1Department of General Surgery, Public health clinical center of chengdu, Chengdu, Sichuan Province, China.
Insights
Depressurization of the portal vein (DPV) before liver transplantation (LT) may reduce hepatocellular carcinoma (HCC) recurrence in early stages. DPV treatment prior to HCC occurrence shows promise in improving outcomes after LT.
Area of Science:
- Hepatobiliary Surgery
- Transplantation Medicine
- Oncology
Background:
- Portal hypertension (PHT) is linked to hepatocellular carcinoma (HCC) development.
- The impact of PHT management before liver transplantation (LT) on HCC recurrence remains unclear.
Purpose of the Study:
- To investigate whether portal vein depressurization (DPV) before LT influences HCC recurrence.
- To analyze the effect of DPV timing relative to HCC diagnosis on post-LT outcomes.
Main Methods:
- A nested case-control study matched 110 patients who underwent DPV operations before LT with 330 preoperative non-DPV patients.
- Subgroup analysis examined DPV timing: before or after HCC occurrence.
Main Results:
- DPV group had higher rates of acute kidney injury and intra-abdominal bleeding post-LT.
- Overall 5-year survival rates were similar between DPV and non-DPV groups (83.4% vs. 82.7%).
- DPV before HCC (TNM I-II stages) was associated with lower HCC recurrence (4.7% vs. 16.8%) and higher tumor-free survival (88.9% vs. 74.4%) compared to other groups.
Conclusions:
- DPV treatment before HCC occurrence can significantly reduce HCC recurrence after early LT (TNM I-II stages).
- DPV prior to LT is beneficial for reducing early HCC recurrence.
Background:
Portal hypertension (PHT) has been proven to be closely related to the development of hepatocellular carcinoma (HCC). Whether PHT before liver transplantation (LT) will affect the recurrence of HCC is not clear.
Methods:
110 patients with depressurization of the portal vein (DPV) operations (Transjugular Intrahepatic Portosystemic Shunt-TIPS, surgical portosystemic shunt or/and splenectomy) before LT from a HCC LT cohort, matched with 330 preoperative non-DPV patients; this constituted a nested case-control study. Subgroup analysis was based on the order of DPV before or after the occurrence of HCC.
Results:
The incidence of acute kidney injury and intra-abdominal bleeding after LT in the DPV group was significantly higher than that in non-DPV group. The 5-year survival rates in the DPV and non-DPV group were 83.4% and 82.7% respectively (P = 0.930). In subgroup analysis, patients in the DPV prior to HCC subgroup may have a lower recurrence rate (4.7% vs.16.8%, P = 0.045) and a higher tumor free survival rate (88.9% vs.74.4%, P = 0.044) after LT under the up-to-date TNMI-II stage, while in TNM III stage, there was no difference for DPV prior to HCC subgroup compared with the DPV after HCC subgroup or the non-DPV group.
Conclusion:
Compared with DPV after HCC, DPV treatment before HCC can reduce the recurrence rate of HCC after early transplantation (TNM I-II). DPV before LT can reduce the recurrence of early HCC.
