Prediction Of Posthepatectomy Liver Failure Research Articles

Predicting liver failure after extended right hepatectomy following right portal vein embolization with gadoxetic acid-enhanced MRI.

Predicting post-hepatectomy liver failure (PHLF) after extended right hepatectomy following portal vein embolization (PVE) from serial gadoxetic acid-enhanced magnetic resonance imaging (MRI). Thirty-six patients who underwent hepatectomy following PVE were evaluated prospectively with gadoxetic acid-enhanced MRI examinations at predefined intervals during the course of their treatment, i.e., before and 14days and 28days after PVE as well as 10days after hepatectomy. Relative enhancement (RE) and volume of the left and right liver lobes were determined. The study population was divided into two groups with respect to signs of PHLF. Differences between the two groups were assessed using the Mann-Whitney U test, and predictive parameters for group membership were investigated using ROC and logistic regression analysis. RE of the left lobe prior to PVE versus 14days after PVE was significantly lower in patients with PHLF than in those without PHLF (Mann-Whitney U test p < 0.001) and proved to be the best predictor of PHLF in ROC analysis with an AUC of 0.854 (p < 0.001) and a cutoff value of - 0.044 with 75.0% sensitivity and 92.6% specificity. Consistent with this result, logistic linear regression analysis adjusted for age identified the same parameter to be a significant predictor of PHLF (p = 0.040). Gadoxetic acid-enhanced MRI performed as an imaging-based liver function test before and after PVE can help to predict PHLF. The risk of PHLF can be predicted as early as 14days after PVE. • To predict the likelihood of post-hepatectomy liver failure, it is important to estimate not only future liver remnant volume prior to extended liver resection but also future liver remnant function. • Future liver remnant function can be predicted by performing gadoxetic acid-enhanced MRI as an imaging-based liver function test before and after portal vein embolization. • A reduction of relative enhancement of the liver in gadoxetic acid-enhanced MRI after portal vein embolization of 0.044 predicts post-hepatectomy liver failure with 75.0% sensitivity and 92.6% specificity.

Systematic review and meta-analysis of thrombocytopenia as a predictor of post-hepatectomy liver failure

BackgroundWe performed a systematic review and meta-analysis to assess whether thrombocytopenia constituted a risk factor for post-hepatectomy liver failure (PHLF). MethodsWe searched MEDLINE and EMBASE from inception until February the 17th, 2018 for studies reporting cases of PHLF in patients with and without thrombocytopenia (defined as a platelet count below 100 or 150 (G/l)) and/or platelet counts in patients with and without PHLF. Pooled odd ratios for PHLF, as well as mean difference in platelet counts between patients with and without PHLF, were obtained by random effects models. Robustness was tested by subgroups and leave-one out sensitivity analyses. Heterogeneity was assessed using the Q-test and quantified based on I2 value. ResultsWe included 15 studies representing 3966 patients. Pooled odds ratio for PHLF in thrombocytopenic patients was 3.71 (95% CI: 2.51 to 5.48; I2 = 0%). Pooled odds ratio was 5.53 (95% CI: 2.85 to 10.48) when pooling only studies based on preoperative platelet count, and 3.13 (95% CI: 1.75 to 5.58) when pooling studies including only patients without liver cirrhosis. The pooled mean difference in platelet counts between patients with and without PHLF was −21.2 (G/l) (95% CI: −36.1 to 6.4) in disfavor of patients with PHLF. When pooling only patients with various qualities of liver tissue, the pooled mean difference was 0.6 (G/l) (95% CI: −21.1 to 22.2). ConclusionPreoperative and/or postoperative thrombocytopenia constitute significant risk factors for PHLF in cirrhotic and non-cirrhotic patients.

Preoperative aspartate aminotransferase-to-platelet-ratio index as a predictor of posthepatectomy liver failure for resectable hepatocellular carcinoma.

PurposeThis study aimed to investigate the efficacy of preoperative aspartate aminotransferase-to-platelet-ratio index (APRI) score to predict the risk of posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) after liver resection, and to compare the discriminatory performance of the APRI with the Child–Pugh score, model for end-stage liver disease (MELD) score, and albumin–bilirubin (ALBI) score.Patients and methodsA total of 1,044 consecutive patients with HCC who underwent liver resection were enrolled and studied. Univariate and multivariate analyses were performed to investigate risk factors associated with PHLF. Predictive discrimination of Child–Pugh, MELD, ALBI, and APRI scores for predicting PHLF were assessed according to area under the ROC curve. The cutoff value of the APRI score for predicting PHLF was determined by ROC analysis. APRI scores were stratified by dichotomy to analyze correlations with incidence and grade of PHLF.ResultsPHLF occurred in 213 (20.4%) patients. Univariate and multivariate analyses revealed that Child–Pugh, MELD, ALBI, and APRI scores were significantly associated with PHLF. Area under the ROC analysis revealed that the APRI score for predicting PHLF was significantly more accurate than Child–Pugh, MELD, or ALBI scores. With an optimal cutoff value of 0.55, the sensitivity and specificity of the APRI score for predicting PHLF were 72.2% and 68.0%, respectively, and the incidence and grade of PHLF in patients with high risk (APRI score >0.55) was significantly higher than in the low-risk cohort (APRI score <0.55).ConclusionThe APRI score predicted PHLF in patients with HCC undergoing liver resection more accurately than Child–Pugh, MELD, or ALBI scores.

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

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

Postoperative serum phosphate drop is an early marker of liver growth after ALPPS stage 1 and predicts outcome after ALPPS stage 2

Background: The accelerated hypertrophy after ALPPS stage-1 is based on rapid cell devision. This process demands tremendous amounts of phosphate for the synthesis of nucleotidetriphosphates during DNA replication. The aim of this study was to analyze whether changes in serum phosphate levels are associated with liver growth and posthepatectomy liver failure (PHLF) after ALPPS. Methods: Serum phosphate changes within the first 7 postoperative days (POD) after ALPPS stage-1 were assessed in 49 patients. All patients underwent volumetric imaging of the future liver remnant before ALPPS and at POD 7 after stage-1. The association of serum phosphate drop (PD) after ALPPS stage-1 with liver hypertrophy after stage-1 and with incidence of PHFL after stage-2 were investigated. Results: After ALPPS stage-1, serum phosphate levels decreased from 1.1 mmol/l (IQR 0.92-1.2) preoperatively to a nadir of 0.7 mmol/l (IQR 0.54-1.02; p< 0.001). The median PD was 40.9%/day (IQR -68.9 to -17.3%/d). Patients with a PD >40%/day showed significantly accelerated liver hypertrophy (median +264ml; IQR 196-347ml) after ALPPS stage-1 as compared with patients with a drop ≤40%/day (median +183ml; IQR 112-211ml; p=0.018). ROC analysis confirmed a PD >40%/day after stage-1 as a predictor of PHLF after ALPPS stage-2 according to 50-50 (AUC 0.769, p=0.015) and ISGLS criteria (AUC 0.760, 0.006). Conclusion: Serum PD represents a novel early predictor of liver growth and PHLF in patients undergoing ALPPS.

Estimated remnant liver function prior to hepatectomy for CR metastasis is a better predictor of post-hepatectomy liver failure than APRI score.

Background: Posthepatectomy liver failure (PHLF) is a major complication after hepatectomy with a high mortality rate. The future remnant liver volume (FLRV%) and the total liver function both influence the occurrence of PHLF. Total liver function can be reduced in chemotherapy associated liver injury (CALI). Different tools predicting PHLF have been described in hepatectomy for colorectal liver metastasis after chemotherapy. Aspartate aminotransferase to platelet ratio index (APRI) has been shown to predict CALI and PHLF related to severe CALI. Estimation of the future liver remnant function (eFLRF) in a formula combining 99mTc-Mebrofenin Hepatobiliary Scintigraphy (HBS) and FLRV% liver volumetry has been shown to predict PHLF. No direct comparison between eFLRF and APRI has been performed up to now. Methods: Estimation of the future liver remnant function (eFLRF) was performed in 140 patients prior to liver resection for colorectal liver metastasis after preoperative systemic therapy. When the cut-off for eFLRF was under 2.3%/min/m2, portal vein embolization or ligation was performed. APRI scores was calculated in all patients. Results: In ROC analysis, FLRV% and eFLRF had a better predictive value for PHLF than HBS alone and APRI. In multivariate analysis, eFLRF seems to be the only predicting factor for PHLF. Conclusion: PHLF is best predicted by combining volumetry with liver function in one formula than by separate volumetric or functional evaluation of the liver.

Estimated remnant liver function prior to hepatectomy for CR metastasis is a better predictor of post-hepatectomy liver failure than APRI score

Estimated remnant liver function prior to hepatectomy for CR metastasis is a better predictor of post-hepatectomy liver failure than APRI score

A nomogram for prediction of post-hepatectomy liver failure in patients with hepatocellular carcinoma

A nomogram for prediction of post-hepatectomy liver failure in patients with hepatocellular carcinoma

Portal hypertension predicts short-term and long-term outcomes after hepatectomy in hepatocellular carcinoma patients

Background and aims: The impact of portal hypertension (PH) on postoperative short-term outcomes and long-term survival in hepatocellular carcinoma (HCC) patients has lately been discussed controversially. This study aimed to explore the influence of PH on postoperative outcomes in HCC patients undergoing surgical resection.Methods: Patients undergoing hepatectomy for HCC from 2010 to 2014 were enrolled. The impact of PH on postoperative complications, posthepatectomy liver failure (PHLF) and overall survival (OS) was evaluated.Results: A total of 355 HCC patients were enrolled; 129 (36.3%) experienced postoperative complications and 21 (5.9%) developed PHLF. PH was identified as an independent predictor of PHLF. Patients with PH experienced a higher incidence of complications and PHLF than patients without PH. On the Cox proportional hazards regression model, PH was verified as a risk factor of OS for BCLC stage 0/A and B patients. Patients without PH had significantly better long-term survival compared to patients with PH both in the total cohort and in cirrhosis subgroup.Conclusion: Liver resection in HCC patients with PH showed a significantly increased postoperative complications and PHLF, and revealed a decreasing long-term survival than non-PH patients. Besides, tumor burden also played an important role in determining the OS. However, due to the improvement in surgical technique and perioperative management, surgery was feasible in carefully selected HCC patients with PH.

Clinical significance of serum prealbumin-bilirubin score (PALBI) in predicting posthepatectomy liver failure in patients with HBV-related hepatocellular carcinoma

Objective To study the value of serum prealbumin - bilirubin score (PALBI) in predicting posthepatectomy liver failure (PHLF) for patients with HBV related hepatocellular carcinoma (HCC). Methods A retrospective study was conducted on 919 HBV-related HCC patients who underwent hepatectomy from September 2013 to December 2016 at the Affiliated Tumor Hospital of Guangxi Medical University. These patients were divided into a training cohort (n=689) and a validation cohort (n=230) using the 3∶1 matching principle. The training cohort was divided into the control group (n=546) and the PHLF group (n=143) according to whether PHLF occurred. The multivariate logistic regression model was used to analyze the factors related to PHLF in the training cohort, and then the PALBI score was established. The ability of the PALBI score to predict PHLF was evaluated by the area under the receiver operating characteristic curve (AUC ) and compared with the Child-Pugh, model for end-stage liver disease (MELD), and albumin-bilirubin (ALBI) scores. Results Univariate and multivariate logistic regression analyses showed the factors including HBV-DNA≥103 IU/ml, total bilirubin, prealbumin, platelet count, AST, prothrombin time, intraoperative blood loss≥400 ml and major liver resection were closely related to PHLF. The ability of the PALBI score (AUC=0.733) to predict PHLF preoperatively was superior to the Child-Pugh score (AUC=0.562), the MELD score (AUC=0.652) and the ALBI score (AUC=0.683) in the entire training cohort. Similar results were obtained in the entire validation cohort (AUC: 0.752 vs. 0.599 vs. 0.641 vs. 0.678). To eliminate the effect of a small residual liver volume on PHLF, the ability of each of these scores in the training and validation cohorts to predict PHLF was calculated respectively in these 2 cohorts of patients who underwent only minor liver resection, and similar results were obtained. Conclusion The PALBI score was significantly superior to the Child-Pugh, MELD and ALBI scores in predicting PHLF in patients with HBV-related HCC who underwent liver resection. The PALBI score is a simple, non-invasive and reliable novel model in predicting PHLF. Key words: Hepatocellular carcinoma; Hepatitis B virus; Post-hepatectomy liver failure; Prealbumin-bilirubin score; Child-Pugh score; Model for end-stage liver disease score

A radiomics-based nomogram for the preoperative prediction of posthepatectomy liver failure in patients with hepatocellular carcinoma

ObjectivesTo develop and validate a radiomics-based nomogram for the preoperative prediction of posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC). MethodsOne hundred twelve consecutive HCC patients who underwent hepatectomy were included in the study pool (training cohort: n = 80, validation cohort: n = 32), and another 13 patients were included in a pilot prospective analysis. A total of 713 radiomics features were extracted from portal-phase computed tomography (CT) images. A logistic regression was used to construct a radiomics score (Rad-score). Then a nomogram, including Rad-score and other risk factors, was built with a multivariate logistic regression model. The discrimination, calibration and clinical utility of nomogram were evaluated. ResultsThe Rad-score could predict PHLF with an AUC of 0.822 (95% CI, 0.726–0.917) in the training cohort and of 0.762 (95% CI, 0.576–0.948) in the validation cohort; however, the approach could not completely outmatch the existing methods (CP [Child-Pugh], MELD [Model of End Stage Liver Disease], ALBI [albumin-bilirubin]). The individual predictive nomogram that included the Rad-score, MELD and performance status (PS) showed better discrimination with an AUC of 0.864 (95% CI, 0.786–0.942), which was higher than the AUCs of the conventional methods (nomogram vs CP, MELD, and ALBI at P < 0.001, P < 0.005, and P < 0.005, respectively). In the validation cohort, the nomogram discrimination was also superior to those of the other three methods (AUC: 0.896; 95% CI, 0.774–1.000). The calibration curves showed good agreement in both cohorts, and the decision curve analysis of the entire cohort revealed that the nomogram was clinically useful. A pilot prospective analysis showed that the radiomics nomogram could predict PHLF with an AUC of 0.833 (95% CI, 0.591–1.000). ConclusionsA nomogram based on the Rad-score, MELD, and PS can predict PHLF.

Ability of the ALBI grade to predict posthepatectomy liver failure and long-term survival after liver resection for different BCLC stages of HCC

BackgroundUnderlying liver function is a major concern when applying surgical resection for hepatocellular carcinoma (HCC). We aimed to explore the capability of the albumin-bilirubin (ALBI) grade to predict post-hepatectomy liver failure (PHLF) and long-term survival after hepatectomy for HCC patients with different Barcelona Clinic Liver Cancer (BCLC) stages.MethodsBetween January 2010 and December 2014, 338 HCC patients who were treated with liver resection were enrolled. The predictive accuracy of ALBI grade system for PHLF and long-term survival across different BCLC stages was examined.ResultsA total of 26 (7.7%) patients developed PHLF. Patients were divided into BCLC 0/A and BCLC B/C categories. ALBI score was found to be a strong independent predictor of PHLF across different BCLC stages by multivariate analysis. In terms of overall survival (OS), it exhibited high discriminative power in the total cohort and in BCLC 0/A subgroup. However, differences in OS between ALBI grade 1 and 2 patients in BCLC B/C subgroup were not significant (P = 0.222).ConclusionThe ALBI grade showed good predictive ability for PHLF in HCC patients across different BCLC stages. However, the ALBI grade was only a significant predictor of OS in BCLC stage 0/A patients and failed to predict OS in BCLC stage B/C patients.

Hepatobiliary scintigraphy combined with SPECT/CT in predicting liver failure before major hepatectomy: preliminary results of the HIBA-index at a single center

Introduction: Hepatobiliary scintigraphy (HBS) is able to estimate future liver remnant function (FLR-F) and may be useful to predict post-hepatectomy liver failure (PHLF) before major hepatectomy. Existing cut-off values for PHLF (FLR-F < 2.69%/min/m2) were previously set using only planar acquisitions but not combined with single photon emission computed tomography (SPECT/CT). A new index, the so-called Hospital Italiano De Buenos Aires index (HIBA-i), has been recently used to measure sectorial liver function in two-stage hepatectomy setting. Method: All consecutive patients submitted to major hepatectomy between November 2016 and November 2017 at Sant'Orsola-Malpighi Hospital (Bologna, Italy), were analyzed. Patients were resected according to their preoperative volumetry. Data regarding preoperative HBS were retrospectively reviewed. FLR-F and HIBA-i were calculated as previously described. PHLF was defined according to the International Study Group of Liver Surgery criteria. Results: Twenty-seven patients were submitted to major hepatectomy (13 right hepatectomies, 8 left hepatectomies, 5 right trisectionectomies, 1 left trisectionectomy). PHLF (grade A/B/C) was observed in 9 out of 27 patients (33.3%). The HIBA-i differed significantly (p=0.002) between patients with (14.37%, IQR 8.64-16.14) and without PHLF (24.31%, IQR 15.74-39.53). Eight of 16 patients with a preoperative FLR-F < 2.69 %/min/m2 did not experienced PHLF. FLR volumes between the two groups did not show any statistical significance. Conclusions: The HIBA-i seems a promising tool able to estimate residual liver function. Prospective clinical trial are warranted to define more precise cut-offs of FLR-F when SPECT/CT is associated.

Preoperative thrombocytopenia may predict poor surgical outcome after extended hepatectomy

Introduction: It is a novel idea that platelet counts may predict the postoperative outcome following liver surgery. This may help in planning an extended hepatectomy (EH), which is a surgical procedure with high morbidity and mortality. The aim of this study was to evaluate the predictive potential of platelet counts on the outcome of EH. Methods: A series of 213 consecutive patients underwent EH (resection of ≥ five liver segments) between 2001 and 2016. The postoperative surgical outcomes were evaluated and compared between patients with a normal preoperative platelet count. The ability of preoperative platelet counts to predict posthepatectomy liver failure (PHLF), morbidity (based on Clavien-Dindo classification), and 30-day mortality was evaluated using multivariate analysis. Results: A total of 213 patients who underwent EH were included in our analyses. PHLF were detected in 26.3% of patients, complications in 26.8% of patients, and 30-day mortality in 11.3% of patients. Multivariate regression analysis revealed that the preoperative platelet count is an independent predictor of PHLF (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.3-15.1, p=0.019) and 30-day mortality (OR 6.3, 95% CI 1.4-27.9, p=0.015). Conclusion: Preoperative platelet counts correlated with PHLF and mortality following extended liver resection. This predictive role was independent of other related parameters. Prospective studies are needed to further evaluate this predictive role and to determine the impact of preoperative correction of platelet count on postoperative outcomes after EH.

Metabolic profiling of fatal liver failure after hepatectomy: value of extemporaneous HR-MAS-NMRmetabolomics

Introduction: The goal of the study was to evaluate real-time metabolomics as a tool to predict posthepatectomy liver failure (PHLF) and identify potential early metabolic biomarkers. Liver metabolism has been scarcely evaluated as a tool to predict liver failure after hepatectomy. The main limitation is represented by techniques used for global metabolism estimation that are not compatible with clinical time. Methods: End-hepatectomy liver biopsies (n=56) and cirrhotic liver biospies (n=36) were analyzed using high-resolution magic-angle spinning nuclear magnetic resonance spectroscopy (Brucker Advance III spectrometer). The metabolic profiles were compared between patients dying from PHLF and patients surviving hepatectomy at high risk of PHLF using PLS-DA. Metabolites significantly associated to fatal liver failure (FLF) were identified through network analysis and compared to metabolites predicting ACLF in an independent cohort of cirrhotic patients. Results: Metabolic profiling could be achieved in 30 minutes. It predicted FLF with an excellent accuracy (Q2=0.516) with a sensibility of 100%. Intrahepatic content in neoglucogenic amino acids (alanine, isoleucine, glutamine and valine; p< 0.05) was significantly higher in patients experiencing FLF as well as low glycerophosphocholine (AUROC=0.856; IC95% 0.738-0.974) and high choline/glycerophosphocholine ratio (p=0.011). The metabolic changes identified in this population were different from those observed in ACLF patients. The changes are consistent with Warburg effect that is observed in multicellular proliferating systems. Conclusion: HR-MAS-NMR metabolomics is a powerful tool to predict liver failure after hepatectomy and is clinically relevant given its real-time application. The identified metabolic derangements could lead to evaluate metabolic intervention to prevent liver failure.

Presurgical functional liver capacitiy assessment before major liver resections: a comparison of 99mTc-mebrofenin hepatobiliary scintigraphy and LiMAx to predict posthepatectomy liver failure

Introduction: Posthepatectomy liver failure (PHLF) is a severe problem after major liver resections and is linked with higher morbidity and mortality. Our goal must be to implement a presurgical routine to measure the current liver function and to calculate future remnant liver function for further individual therapeutic decisions. This study investigates postoperative outcome by comparing 99mTc-mebrofenin hepatobiliary scintigraphy and maximum liver function capacity test (LIMAx). Methods: We performed a full presurgical liver capacity assessment in 13 patients before major liver resections because of hepatobiliary malignancies. We compared the results of the hepatobiliary scintigraphy to the LIMAx-Test to detect posthepatectomy liver failure (50-50 criteria, peak-bili 7, ISGLS-criteria) and postoperative complications (Dindo-Clavien Classification, CCI). Results: 9 patients showed critical levels in the 99mTc-mebrofenin hepatobiliary scintigraphy (< 2.7 %/min/m2) and 4 patients in the LiMAx-Test (< 100 μg/h/kg). PHLF appeared in 3 patients according to the ISGLS-criteria (1 ISGLS-A, 2 ISGLS-B). In total 4 patients met the requirements of the Peak-Bili-7 criteria including the above-mentioned 3 patients. Two of the 4 patients were not recognized as critical by preoperative functional liver assessment, neither by scintigraphy nor by LiMAx. The Evaluation of postoperative complications based on the Dindo-Clavien Classification (IIIb or higher) occurred in 3 patients. The 90-day mortality was 0%. Conclusion: Both methods, 99mTc-mebrofenin scintigraphy and LiMAx, can be used to improve the prediction of posthepatectomy liver failure. For better accuracy and reliability further investigations are necessary.

Usefulness of functional remnant liver volume assessment using EOB-MRI to predict posthepatectomy liver failure in hepatectomy of more than one segment

Introduction: Several reports described Gd-EOB-DTPA-enhanced MRI (EOB-MRI) can be potentially used for evaluation of liver function. This modality has better versatility and spatial resolution compared with 99mTc-GSA scintigraphy. We assessed whether functional remnant liver volumetry (FRLV) using EOB-MRI predicted post hepatectomy liver failure (PHLF). Method: We retrospectively analyzed 114 cases performed hepatectomy of more than one segment (MOS). Signal intensity (SI) of remnant liver were measured by putting region of interest in T1WI image. SI of spinal erector muscle and spleen were calculated for standardization of SI value. Functional remnant liver score was derived in division of average SI of liver by average SI of muscle (or spleen) as liver-muscle ratio(LMR) and liver-spleen ratio(LSR), respectively. Future remnant volume was calculated by volume analyzer, then FRLV was calculated by multiplying LMR(or LSR) and remnant volume. Standardized FRLV(sFRLV) was calculated by dividing FRLV by body surface area. Definition of PHLF is used ISGLS classification. Results: LMR correlated with ICG-R15(p=0.004), but not LSR, FRLV or sFRLV. PHLF(≥GradeB) occurred in 5 patients (4.4%). In univariate analysis, predictive factors of PHLF were operative time(p=0.010), blood loss(p=0.013), FRLV(LMR) (p=0.021), sFRLV(LMR)(p=0.015), FRLV(LSR)(p=0.040), and sFRLV(LSR)(p=0.044). In multivariate analysis, only sFRLV(LMR) was independent predictive factor of PHLF(p=0.042). ROC analysis revealed that cut-off value of sFRLV(LMR) predicting PHLF was 599ml/m2(AUC: 0.913). In analysis of PTPE cases (n=17), 10 cases over cut-off of sFRLV did not occur PHLF, but 7 cases lower than cut-off occurred PHLF in 4 patients (57%) (p=0.019). Conclusion: sFRLV using EOB-MRI predicts PHLF in hepatectomy of MOS.

Meta-analysis of the prognostic role of perioperative platelet count in posthepatectomy liver failure and mortality.

Emerging evidence suggests that the perioperative platelet count (PLT) can predict posthepatectomy liver failure (PHLF). In this systematic review and meta-analysis, the impact of perioperative PLT on PHLF and mortality was evaluated. MEDLINE and Web of Science databases were searched systematically for relevant literature up to January 2018. All studies comparing PHLF or mortality in patients with a low versus high perioperative PLT were included. Study quality was assessed using methodological index for non-randomized studies (MINORS) criteria. Meta-analyses were performed using Mantel-Haenszel tests with a random-effects model, and presented as odds ratios (ORs) with 95 per cent confidence intervals. Thirteen studies containing 5260 patients were included in the meta-analysis. Two different cut-off values for PLT were used: 150 and 100/nl. Patients with a perioperative PLT below 150/nl had higher PHLF (4 studies, 817 patients; OR 4·79, 95 per cent c.i. 2·89 to 7·94) and mortality (4 studies, 3307 patients; OR 3·78, 1·48 to 9·62) rates than patients with a perioperative PLT of 150/nl or more. Similarly, patients with a PLT below 100/nl had a significantly higher risk of PHLF (4 studies, 949 patients; OR 4·65, 2·60 to 8·31) and higher mortality rates (7 studies, 3487 patients; OR 6·35, 2·99 to 13·47) than patients with a PLT of 100/nl or greater. A low perioperative PLT correlates with higher PHLF and mortality rates after hepatectomy.

Interstage Assessment of Remnant Liver Function in ALPPS Using Hepatobiliary Scintigraphy: Prediction of Posthepatectomy Liver Failure and Introduction of the HIBA Index.

The aim of this study was to evaluate interstage liver function in associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) using hepatobiliary scintigraphy (HBS) and whether this may help to predict posthepatectomy liver failure (PHLF). ALPPS remains controversial given the high rate of liver-related mortality after stage 2. HBS combined with single photon emission computed tomography (SPECT) accurately estimates future liver remnant function and may be useful to predict PHLF. Between 2011 and 2016, 20 of 39 patients (51.3%) underwent SPECT-HBS before ALPPS stage 2 for primary (n = 3) or secondary liver tumors (n = 17) at the Hospital Italiano de Buenos Aires (HIBA). PHLF was defined by the International Study Group of Liver Surgery criteria, 50-50 criteria, or peak bilirubin >7 mg/dL. Grade A PHLF was excluded, as it requires no change in clinical management. Receiver-operating characteristic curves were used to determine cutoff for HBS parameters. 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 cutoff <15% was 80%, whereas no patient with cutoff ≥15% developed PHLF. 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. Although further studies are needed to confirm our findings, the routine application of this noninvasive low-cost examination could facilitate decision-making in institutions performing ALPPS.

Value of the preoperative Child-Pugh score and albumin-bilirubin score predicting posthepatectomy liver failure and prognosis of patients with hepatocellular carcinoma

Objective To investigate the value of the preoperative Child-Pugh score and albumin-bilirubin (ALBI) score predicting posthepatectomy liver failure (PHLF) and prognosis of patients with hepatocellular carcinoma (HCC). Methods The retrospective cohort study was conducted. The clinical data of 226 HCC patients who were admitted into the People′s Hospital of Peking University between January 2010 and October 2014 were collected. After preoperative related examinations, feasibility and extent of liver resection were discussed according to patients′ conditions by multidisciplinary team, and then surgery was performed. Observation indicators: (1) surgical situations; (2) factors analysis affecting PHLF of HCC patients; (3) receiver operating characteristic (ROC) curve analysis of Child-Pugh and ALBI scores predicting PHLF; (4) follow-up and survival situations; (5) prognosis analysis of HCC patients after hepatectomy. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to August 2016. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (P25, P75). The survival curve was drawn by the Kaplan-Meier method, and the Log-rank test was used for survival analysis. The influencing factors of PHLF were analyzed using the logistic regression model. The prognostic factors were analyzed by the COX regression model. ROC analysis was used for predictive value of Child-Pugh and ALBI scores. Results (1) Surgical situations: 226 patients underwent successful surgery, including 171 receiving localized liver resection ( 0.05). Conclusion Preoperative ALBI score in predicting PHLF is superior to that of Child-Pugh score, but ALBI score is not independent factor affecting prognosis of HCC patients. Key words: Hepatic neoplasms; Child-Pugh score; Albumin-bilirubin score; Posthepatectomy liver failure; Prognosis