Reuters Health Information: Cholangitis slows liver increase after portal vein embolization
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
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
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
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
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
Dr. Nagino did not respond to requests for comments.