Functional considerations in ALPPS – consequences for clinical management

Abstract

BackgroundSince perioperative morbidity and mortality in ALPPS are extraordinarily high, a deeper understanding of actual liver function during the procedure is essential to make the approach safer. MethodsData from 17 patients who underwent ALLPS were analyzed regarding their course of liver function capacity assessed with the LiMAx test and compared to an equal-sized matched cohort of patients that underwent PVE. ResultsA comparison of LiMAx prior to and following ALPPS Step I (330 [258–385] vs. 197 [144–224] μg/kg/h, p = 0.003) and prior to and following PVE (386 [330–519] vs. 378 [336–455] μg/kg/h, p = 0.534) demonstrated a significant drop in function after ALLPS. A volume/function analysis predicting FLR function regarding step II revealed an excellent correlation of predicted versus assessed postoperative liver function with a mean relative difference of 9 (−6 to 18)% and an ICC of 0.905 (123 [74–138] vs. 107 [77–175] μg/kg/h, p = 0.310). ConclusionsWe provide evidence that liver function capacity is significantly impaired due to ALPPS step I. This is particularly notable when compared to PVE. Our data also shows that the portal ligated liver lobe still continues to contribute significantly to overall liver function. Therefore, FLR function after step II is still predictable by volume/function analysis.