Interstage assessment of remnant liver function in ALPPS using hepatobiliary scintigraphy: introduction of the HIBA index

Abstract

Background: ALPPS remains controversial given the high rate of liver-related mortality after stage-2. Hepatobiliary scintigraphy (HBS) combined with single photon emission computed tomography (SPECT) could accurately estimates future liver remnant (FLR) function. Our aim was to evaluate interstage liver function in ALPPS using HBS and whether this may help to predict posthepatectomy liver failure (PHLF). Methods: Between 2011 and 2016, 20/39 patients (51.3%) underwent SPECT-HBS before ALPPS stage-2 for primary (n=3) or secondary liver tumors (n=17). PHLF was defined by the International Study Group of Liver Surgery (ISGLS) criteria, 50-50 criteria or peak bilirubin >7 mg/dl. Grade A PHLF was excluded, as it requires no change in clinical management. Different HBS parameters were evaluated. Results: Interstagely, 3 HBS parameters differed significantly between patients with (n=4) and without PHLF (n=16) after stage-2. Among these, the HIBA-index best predicted PHLF, with a cutoff value of 15%. The risk of PHLF in patients with HIBA-index<15% was 80%, whereas no patient withHIBA-index ≥15% developed PHLF Conclusion: Interstage HBS could help to predict clinically significant PHLF after ALPPS stage-2. An HIBA-index cutoff of 15% seemed to give the best diagnostic performance. While further studies are needed to confirm our findings, the routine application of this non-invasive low-cost exam could facilitate decision-making in institutions performing ALPPS