Comments on combining albumin-bilirubin score with future liver remnant predicts posthepatectomy liver failure in HBV-associated HCC patients

2017 ◽  
Vol 38 (4) ◽  
pp. 761-761 ◽  
Author(s):  
Saeid Safiri ◽  
Erfan Ayubi
Keyword(s):  
Liver Failure ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Posthepatectomy Liver Failure

scholarly journals Major Hepatectomy in a Child with Extremely Low Future Liver Remnant Without Posthepatectomy Liver Failure

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S201
Author(s):  
D. Akhaladze ◽  
D. Kachanov ◽  
G. Rabaev ◽  
N. Merkulov ◽  
N. Uskova ◽  
...  
Keyword(s):  
Liver Failure ◽  
Major Hepatectomy ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Posthepatectomy Liver Failure

Validation of the Conventional Resection Criteria in Patients with Hepatocellular Carcinoma in Terms of the Incidence of Posthepatectomy Liver Failure and Long-Term Prognosis

2015 ◽  
Vol 32 (5) ◽  
pp. 344-351 ◽  
Author(s):  
Kohta Iguchi ◽  
Etsuro Hatano ◽  
Kenya Yamanaka ◽  
Shiro Tanaka ◽  
Kojiro Taura ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Failure ◽  
Disease Free Survival ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Free Survival ◽  
Posthepatectomy Liver Failure ◽  
Long Term Prognosis ◽  
Patient Prognosis

Background/Aims: Resection criteria in hepatocellular carcinoma (HCC) should be established based on the risk of posthepatectomy liver failure (PHLF) and the survival benefit from hepatectomy. This study aimed at verifying the validity of the conventional criteria regarding the incidence of PHLF and the long-term prognosis of HCC patients. Methods: A retrospective study was performed on 265 patients who underwent major hepatectomy. Makuuchi's criteria and the future liver remnant plasma clearance rate of indocyanine green (ICGK-rem) ≥0.05 criterion were evaluated. Results: A total of 107 and 158 patients were within and beyond Makuuchi's criteria, respectively. Makuuchi's criteria were associated with the incidence of PHLF (p = 0.03) but not with its severity (p = 0.12). No differences in disease-free survival (DFS) or overall survival (OS) were observed between the groups (p = 0.75 and p = 0.94, respectively). Using the ICGK-rem ≥0.05 criterion, 223 and 42 patients were within and beyond the criterion, respectively. ICGK-rem was correlated with both the incidence of PHLF (p = 0.002) and its severity (p = 0.03). No differences in DFS or OS were observed between the groups (p = 0.75 and p = 0.29, respectively). Conclusions: Strict criteria are likely to preclude some patients from obtaining the greater survival benefits of hepatectomy. New criteria that consider patient prognosis are needed.

scholarly journals Assessment of Liver Remnant Using ICG Clearance Intraoperatively during Vascular Exclusion: Early Experience with the ALIIVE Technique

HPB Surgery ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Lawrence Lau ◽  
Christopher Christophi ◽  
Mehrdad Nikfarjam ◽  
Graham Starkey ◽  
Mark Goodwin ◽  
...  
Keyword(s):  
Liver Failure ◽  
Major Hepatectomy ◽  
Significant Risk ◽  
Future Liver Remnant ◽  
Preoperative Assessment ◽  
Parenchymal Transection ◽  
Liver Remnant ◽  
Posthepatectomy Liver Failure ◽  
Vascular Exclusion ◽  
Icg Clearance

Background. The most significant risk following major hepatectomy is postoperative liver insufficiency. Current preoperative assessment of the future liver remnant relies upon assumptions which may not be valid in the setting of advanced resection strategies. This paper reports the feasibility of the ALIIVE technique which assesses the liver remnant with ICG clearance intraoperatively during vascular exclusion. Methods. 10 patients undergoing planned major liver resection (hemihepatectomy or greater) were recruited. Routine preoperative assessment included CT and standardized volumetry. ICG clearance was measured noninvasively using a finger spectrophotometer at various time points including following parenchymal transection during inflow and outflow occlusion before vascular division, the ALIIVE step. Results. There were one case of mortality and three cases of posthepatectomy liver failure. The patient who died had the lowest ALIIVE ICG clearance (7.1%/min versus 14.4 ± 4.9). Routine preoperative CT and standardized volumetry did not predict outcome. Discussion/Conclusion. The novel ALIIVE technique is feasible and assesses actual future liver remnant function before the point of no return during major hepatectomy. This technique may be useful as a check step to offer a margin of safety to prevent posthepatectomy liver failure and death. Further confirmatory studies are required to determine a safety cutoff level.

scholarly journals Prognostic value of future liver remnant LU15 index of 99mTc-galactosyl serum albumin scintigraphy for predicting posthepatectomy liver failure

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247675
Author(s):  
Koichi Tomita ◽  
Naokazu Chiba ◽  
Shigeto Ochiai ◽  
Takahiro Gunji ◽  
Kosuke Hikita ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Serum Albumin ◽  
Liver Failure ◽  
Characteristic Curve ◽  
Future Liver Remnant ◽  
International Study ◽  
Liver Uptake ◽  
Liver Remnant ◽  
Posthepatectomy Liver Failure ◽  
Definition Of

There is no gold standard indicator that is currently used to predict posthepatectomy liver failure (PHLF). A novel indicator of liver function, the LU15 index of 99mTc-galactosyl serum albumin (GSA) scintigraphy, refers to the liver uptake ratio over a 15-min interval. We aimed to evaluate the usefulness of the future liver remnant (FLR)-LU15 in predicting PHLF. The clinical data of 102 patients (70 males and 32 females; median age, 70 years) who underwent liver resection between January 2011 and August 2019 were analyzed. The FLR-LU15 was calculated by a fusion of simulated 3-dimensional images and 99mTc-GSA scintigraphy. PHLF was determined according to the definition of the International Study Group of Liver Surgery. The FLR-LU15 was an independent risk factor for PHLF ≥ Grade B according to multivariate analysis, and its value correlated with the PHLF grade. The area under the receiver operating characteristic curve of the FLR-LU15 for PHLF ≥ Grade B was 0.816 (95% confidence interval, 0.704–0.929), which was better than that of other indicators. When the cut-off value of FLR-LU15 was set at 16.7, the sensitivity was 86.7%, specificity was 74.7%, and odds ratio was 19.2 (95% confidence interval, 4.0–90.9), all of which were superior to other indicators. If the cut-off value was 13, the positive predictive value was 57.1%. The FLR-LU15 is a useful predictor of PHLF and may be more reliable than other predictors.

scholarly journals Search threshold values of future liver remnant function and volume for extensive resections in children

2021 ◽  
Vol 26 (3) ◽  
pp. 104-111
Author(s):  
D. G. Akhaladze ◽  
G. S. Rabaev ◽  
N. N. Merkulov
Keyword(s):  
Liver Failure ◽  
Future Liver Remnant ◽  
International Normalized Ratio ◽  
Threshold Values ◽  
Liver Remnant ◽  
Posthepatectomy Liver Failure ◽  
The Future ◽  
Future Liver Remnant Volume ◽  
And Function ◽  
Liver Remnant Volume

Aim. To evaluate the relationship between the future liver remnant volume and function and determine the possible threshold values of these parameters for predicting posthepatectomy liver failure in children.Methods. Data of 57 patients who underwent major hepatectomy from July 2017 to February 2021 were retrospectively analyzed. Before surgery all children underwent the CT-volumetry and 99mTc-Mebrofenin hepatobiliary scintigraphy. The threshold values for the future liver volume and function were considered 25%, and 2.7%/min/m2 , respectively. After surgery the ISGLS and 50–50 criteria for posthepatectomy liver failure were assessed. The principal components method was used to identify risk factors for its development. The correlation analysis included the maximum value of total bilirubin after hepatectomy, as well as the values of total bilirubin, albumin, urea, prothrombin index, international normalized ratio and platelets on the postoperative day 5.Results. The posthepatectomy liver failure was observed in 2 patients: grade B developed in a patient with FLR-V 43%, FLR-F 1.8%/min/m2 , grade A in a patient with FLR-V 16.5% and FLR-F 4.78%/min/m2 . A significant statistical relationship of average strength was revealed between the indicators of FLR-F and FLR-V (Pearson η = 0.409; p < 0.01). However, direct pairwise comparison did not reveal the relationship between future liver remnant volume, function and the laboratory parameters. The principal components analysis showed that during the postoperative period, the prothrombin index and international normalized ratio value were the most sensitive to the large volume of the liver parenchyma loss. The threshold value of FLR-F (3%/min/m2 ) was calculated. The decrease below this value can lead to posthepatectomy liver failure, which will manifest as a hemostasis disorder.Conclusion. Planning a one-staged hepatectomy not only the future liver remnant volume should be taken into account, but also its function. The threshold for future liver remnant volume in children is below the generally accepted level 25%. To perform one-stage hepatectomies in such patients, the FLR-F must be at least 2.7%/min/m2 . The future investigations in this field is waranteed.

scholarly journals Extensive liver resection in a child with an extremely low future liver remnant volume

2021 ◽  
Vol 20 (4) ◽  
pp. 139-144
Author(s):  
D. G. Akhaladze ◽  
G. S. Rabaev ◽  
N. N. Merkulov ◽  
I. V. Tverdov ◽  
N. S. Grachev
Keyword(s):  
Liver Failure ◽  
Future Liver Remnant ◽  
Adult Patients ◽  
Two Stage ◽  
Functional Reserve ◽  
Liver Remnant ◽  
Posthepatectomy Liver Failure ◽  
The Future ◽  
Future Liver Remnant Volume ◽  
Liver Remnant Volume

The incidence of posthepatectomy liver failure in adult patients and a large number of complications of two-stage liver resections require a search for criteria that allow highly accurate assessment of the risk of liver failure. For this purpose, the study of the future liver remnant volume and function have been widely introduced among adult patients, and the future liver remnant function measurement reflects the greater sensitivity. The absence of references to posthepatectomy liver failure, as well as the experience of determining the functional reserve of the future liver remnant in children, let us to suggest the possibility of a wider using one-stage liver resections when the future liver remnant volume is below the generally accepted threshold (25% of the healthy liver parenchyma volume) in the case of the functional reserve sufficient value. This clinical case describes the successful extended right hemihepatectomy and segmentectomy 1 in a 3-year patient with a future liver remnant volume of 16.5% without clinical signs of postresection hepatic failure, which confirms the thesis of the need to assess the functional liver reserve in pediatric oncology to reduce the frequency of two-stage resections and liver transplants. The patient’s parents gave consent to the use of their child’s data, including photographs, for research purposes and in publications. 

scholarly journals Perturbations of urea cycle enzymes during posthepatectomy rat liver failure

2019 ◽  
Vol 317 (4) ◽  
pp. G429-G440
Author(s):  
Michelle Meier ◽  
Anders Riegels Knudsen ◽  
Kasper Jarlhelt Andersen ◽  
Maja Ludvigsen ◽  
Peter Lykke Eriksen ◽  
...  
Keyword(s):  
Protein Expression ◽  
Liver Failure ◽  
Liver Tissue ◽  
Urea Cycle ◽  
Selected Reaction Monitoring ◽  
Special Focus ◽  
Sham Operation ◽  
Liver Remnant ◽  
Posthepatectomy Liver Failure ◽  
Arginase 1

Posthepatectomy liver failure (PHLF) may occur after extended partial hepatectomy (PH). If malignancy is widespread in the liver, the size of PH and hence the size of the future liver remnant (FLR) may limit curability. We aimed to characterize differences in protein expression between different sizes of FLRs and identify proteins specific to the regenerative process of minimal-size FLR (MSFLR), with special focus on postoperative day (POD) 1 when PHLF is present. A total of 104 male Wistar rats were subjected to 30, 70, or 90% PH (MSFLR in rats), sham operation, or no operation. Blood and liver tissue were harvested at POD1, 3, and 5 ( n = 8 per group). Protein expression was assessed by proteomic profiling by unsupervised two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) liquid chromatography tandem mass spectrometry (LC-MS/MS), followed by supervised selected reaction monitoring (SRM)-MS/MS. In all, 1,035 protein spots were detected, 54 of which were significantly differentially expressed between groups and identifiable. During PHLF after PH(90%) at POD1, urea cycle and related proteins showed significant perturbations, including the urea cycle flux-regulating enzyme of carbamoyl phosphate synthase-1, ornithine transcarbamylase, and arginase-1, as well as the ornithine aminotransferase and propionyl-CoA carboxylase alpha chain. Plasma-ammonia increased significantly at POD1 after PH(90%), followed by a prompt decrease. At the protein level, we found perturbations of urea cycle and related enzymes in the MSFLR during PHLF. Our results suggest that these perturbations may augment urea cycle function, which may be pivotal for increased ammonia elimination after extensive PHs and potential PHLF. NEW & NOTEWORTHY Posthepatectomy liver failure (PHLF) is associated with high mortality. In a rat model of 90% hepatectomy, PHLF is present. Our results on liver tissue proteomics suggest that the ability of the liver remnant to sufficiently eliminate ammonia may be brought about by perturbation related to urea cycle proteins and that enhancing the urea cycle capacity may play a key role in surviving PHLF.

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