Cholangitis slows liver increase after portal vein embolization

Last Updated: 2014-07-29

By David Douglas

NEW YORK (Reuters Health) - Preoperative cholangitis may have a negative impact on the hepatic regeneration rate after portal vein embolization (PVE) and on subsequent major hepatectomies, according to Japanese researchers. The findings echo those in a rat model.

In a July 10 online paper in Surgery, Dr. Masato Nagino and colleagues at Nagoya University Graduate School of Medicine note that a PVE before an extended hepatectomy has become a standard interventional procedure to increase the future liver remnant volume.

In the normal liver, an approximately 10% embolized lobe volume decrease and a 10% nonembolized lobe increase can be expected within 3 weeks of PVE. However, in previous studies in rats the team found that the presence of segmental cholangitis appeared to be detrimental to the liver regeneration process. Liver regeneration inhibiting factor expression was greater in these animals.

However, it is unclear whether there is such a negative effect in the clinical setting. To investigate further, the team retrospectively examined data on 450 patients who underwent preoperative PVEs and subsequent major hepatectomies between 1991 and 2012.

In all, 72 (16.0%) had preoperative cholangitis. The average volume increase in the nonembolized lobe after PVE was almost identical in both the cholangitis (10.0%) and non-cholangitis (9.5%) groups.

However, the daily nonembolized lobe increase rate percentage was significantly lower in the cholangitis group than in the non-cholangitis group (0.49% vs. 0.62%, respectively). The average time required to acquire institutional safety criteria based on measurements of the plasma disappearance rate of indocyanine green was significantly longer in the cholangitis group than in those without the condition (24.3 days vs. 18.3 days).

Postoperative hospital stay was also longer in the cholangitis group (53 days vs. 44 days). Morbidity was greater (78% vs. 56%) as was the postoperative maximum serum total bilirubin level (8.1 mg/dL vs. 5.7 mg/dL).

The remnant liver function and hepatic regeneration rates after the major hepatectomies were not routinely evaluated, but the researchers say that multivariate logistic regression analyses show that "the presence of preoperative cholangitis is one of the independent risk factors for overall morbidity."

Moreover, they conclude, "based on the results in our previous experimental study using the rat segmental cholangitis model, we believe that the posthepatectomy remnant liver function can be at least partly jeopardized by the presence of a biliary infection, and this situation should be avoided preoperatively as much as possible."

Commenting on the findings by email, gastroenterologist Dr. Keith Lindor of the College of Health Solutions, Arizona State University in Phoenix agreed with the authors' conclusions, pointing out that, "Careful perioperative management of these patients is indeed called for when such procedures are required."

Dr. Nagino did not respond to requests for comments.

SOURCE: http://bit.ly/1pB7H9v

Surgery 2014.