Abstract
BackgroundAccurate estimation of the hepatic functional reserve before liver resection is important to avoid post-hepatectomy liver failure (PHLF). The aim of the present study was to evaluate the association of indocyanine green retention test with portal pressure by the cause of cirrhosis (non-viral vs. viral) and assessed postoperative outcomes including incidence of PHLF in patients with viral and non-viral cirrhosis.MethodsThe cohort includes 50 consecutive patients with liver cirrhosis scheduled for liver resection for primary liver tumors at the Lausanne University Hospital between 2009 and 2018.ResultsThere were 31 patients with non-viral liver cirrhosis (Non-virus group) and 19 with viral liver cirrhosis (virus group). The indocyanine green retention rate at 15 min (ICG-R15) (p = 0.276), Hepatic Venous Portal Gradient (HVPG; p = 0.301), and postoperative outcomes did not differ between the non-virus group and viral group. ICG-R15 and HVPG showed a significant linear correlation in all patients (Spearman’s rank correlation coefficient, ρ = 0.599, p < 0.001), the non-virus group (ρ = 0.555, p = 0.026), and the virus group (ρ = 0.534, p = 0.007). A receiver operating characteristic curve analysis showed that ICG-R15 was a predictor for presence of portal hypertension (PH; HVPG ≥ 12 mmHg) (area under the curve [AUC] = 0.780). The cut-off value of ICG-R15 for predicting the presence of PH was 16.0% with 72.3% of sensitivity and 79.0% of specificity.ConclusionsThe ICG-R15 level was associated with portal pressure in both patients with non-virus cirrhosis and patients with virus cirrhosis and predicts the incidence of PH with relatively good discriminatory ability.Clinical trial numberhttps://clinicalTrials.gov(ID:NCT00827723)Local ethics committee numberCER-VD 251.08
Highlights
Post-hepatectomy liver failure (PHLF) is a severe complication associated with the high mortality rate [1, 2]
The aim of the present study was to evaluate the association of indocyanine green retention test with portal pressure by the cause of cirrhosis and assessed postoperative outcomes including incidence of posthepatectomy liver failure (PHLF) in patients with viral and non-viral cirrhosis
The indocyanine green retention rate at 15 min (ICG-R15) level was associated with portal pressure in both patients with non-virus cirrhosis and patients with virus cirrhosis and predicts the incidence of portal hypertension (PH) with relatively good discriminatory ability
Summary
Post-hepatectomy liver failure (PHLF) is a severe complication associated with the high mortality rate [1, 2]. Accurate estimation of the hepatic functional reserve before liver resection is important to avoid PHLF [3]. Portal hypertension (PH) is a known factor associated with liver cirrhosis and poor liver function. Recent studies and guidelines suggested that hepatectomy for patients with PH should not be a contraindication. PH is not a contraindication for liver resection in Asia, where indocyanine green retention rate at 15 min (ICG-R15) is widely used to evaluate hepatic functional reserve for avoiding PHLF [7–9]. Accurate estimation of the hepatic functional reserve before liver resection is important to avoid posthepatectomy liver failure (PHLF). The aim of the present study was to evaluate the association of indocyanine green retention test with portal pressure by the cause of cirrhosis (non-viral vs viral) and assessed postoperative outcomes including incidence of PHLF in patients with viral and non-viral cirrhosis
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