Abstract
BackgroundLiver stiffness measurement (LSM) using transient elastography has recently become available for the assessment of liver fibrosis. Whether LSM can predict the functional liver reserve in patients undergoing liver resection is not certain.AimTo correlate liver stiffness measurement (LSM) with indocyanine green (ICG) clearance test and liver biochemistry, and to determine its usefulness in predicting postoperative outcomes in patients undergoing liver resection.Patients and MethodsTransient elastography and ICG clearance test were performed pre-operatively in 44 patients with hepatocellular carcinoma. The LSM and ICG retention rate at 15 minutes (R15) were correlated with pre-operative factors and post-operative outcomes.ResultsThere was significant correlation between ICG R15 and LSM. In patients with LSM ≥11 kPa vs <11 kPa, there was significantly higher ICG R15 (17.1% vs 10.0% respectively, p = 0.025). For patients with ICG R15≥10% compared to those <10%, there was significantly higher LSM (12.0 vs 7.6 kPa respectively, p = 0.015). Twenty-eight patients proceeded to resection. There was a significant correlation between LSM and the peak INR after liver resection (r = 0.426, p = 0.024). There was a significant correlation between ICG R15 and the post-operative peak AST level (r = −0.414, p = 0.029) and peak ALT level (r = −0.568, p = 0.002). The operative time was a significant independent factor associated with post-operative complications and peak INR.ConclusionLSM correlated well with ICG R15 in patients undergoing liver resection, and predicted early post-operative complications. Addition of LSM to ICG R15 testing may provide better prognostic information for patients undergoing resection.
Highlights
Liver stiffness measurement (LSM) using transient elastography has recently become available for the assessment of liver fibrosis
For patients with indocyanine green (ICG) rate at 15 minutes (R15)$10% compared to those,10%, there was significantly higher LSM (12.0 vs 7.6 kPa respectively, p = 0.015)
The current study aims to correlate LSM with ICG clearance test and routine liver biochemistry, and to determine its usefulness in predicting postoperative outcomes in patients with Hepatocellular carcinoma (HCC) undergoing liver resection
Summary
Liver stiffness measurement (LSM) using transient elastography has recently become available for the assessment of liver fibrosis. Whether LSM can predict the functional liver reserve in patients undergoing liver resection is not certain. In patients with HCC, the remnant liver is often abnormal due to underlying chronic liver disease. For patients with HCC, bridging fibrosis or established cirrhosis is frequently observed in the non-tumour tissue. It is of paramount importance that the underlying liver function is not severely compromised to cause decompensation and death after liver resection. The Child Pugh classification, and the Model for End-stage Liver Disease (MELD) score provides an estimation of the severity of liver disease, but cannot predict the liver synthetic function reserve, or the ability of the liver to regenerate after resection [2,3,4]
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