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Liver kinetic growth rate predicts postoperative liver failure after ALPPS


Kambakamba, Patryk; Stocker, Daniel; Reiner, Cäcilia S; Nguyen-Kim, Thi Dan; Linecker, Michael; Eshmuminov, Dilmurodjon; Petrowsky, Henrik; Clavien, Pierre-Alain; Lesurtel, Mickael (2016). Liver kinetic growth rate predicts postoperative liver failure after ALPPS. HPB, 18(10):800-805.

Abstract

BACKGROUND Posthepatectomy liver failure (PHLF) may occur after ALPPS (Associating liver partition and portal vein ligation for staged hepatectomy) despite a sufficient standardized future liver remnant (sFLR) volume. The aim of this study was to test kinetic growth rate (KGR) after ALPPS stage 1, describing the percentage increase of sFLR per day, as a predictor of PHLF after completion of ALPPS. METHODS The ability of KGR to predict PHLF after ALPPS stage 2 was investigated in 38 patients. PHLF was defined according to the "50-50" and ISGLS criteria. RESULTS Completion of ALPPS was achieved in 95% (36/38) of patients. The incidence of PHLF was 22% (8/36) and 36% (13/36) according to "50-50" and ISGLS criteria, respectively. Whereas a sFLR cut off at 30% alone failed to predict PHLF, KGR ≥6%/day after stage 1 was associated with a significant reduced risk of PHLF ("50-50", p = 0.03/ISGLS, p = 0.03) after stage 2. Adherence to both concomitant KGR ≥6%/day and sFLR ≥30% reduced the incidence of PHLF to 0%. CONCLUSIONS Assessment of KGR is a novel tool to estimate the risk of PHLF after ALPPS. Respecting KGR and sFLR after ALPPS stage 1 may increase safety in patients undergoing ALPPS.

Abstract

BACKGROUND Posthepatectomy liver failure (PHLF) may occur after ALPPS (Associating liver partition and portal vein ligation for staged hepatectomy) despite a sufficient standardized future liver remnant (sFLR) volume. The aim of this study was to test kinetic growth rate (KGR) after ALPPS stage 1, describing the percentage increase of sFLR per day, as a predictor of PHLF after completion of ALPPS. METHODS The ability of KGR to predict PHLF after ALPPS stage 2 was investigated in 38 patients. PHLF was defined according to the "50-50" and ISGLS criteria. RESULTS Completion of ALPPS was achieved in 95% (36/38) of patients. The incidence of PHLF was 22% (8/36) and 36% (13/36) according to "50-50" and ISGLS criteria, respectively. Whereas a sFLR cut off at 30% alone failed to predict PHLF, KGR ≥6%/day after stage 1 was associated with a significant reduced risk of PHLF ("50-50", p = 0.03/ISGLS, p = 0.03) after stage 2. Adherence to both concomitant KGR ≥6%/day and sFLR ≥30% reduced the incidence of PHLF to 0%. CONCLUSIONS Assessment of KGR is a novel tool to estimate the risk of PHLF after ALPPS. Respecting KGR and sFLR after ALPPS stage 1 may increase safety in patients undergoing ALPPS.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Visceral and Transplantation Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:11 August 2016
Deposited On:25 Aug 2016 10:19
Last Modified:07 Oct 2016 01:02
Publisher:Elsevier
ISSN:1365-182X
Publisher DOI:https://doi.org/10.1016/j.hpb.2016.07.005
PubMed ID:27524732

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