Background:We previously showed that embolization of portal inflow and hepatic vein(HV)outflow(liver venous deprivation,LVD)promotes future liver remnant(FLR)volume(FLR-V)and function(FLR-F)gain.Here,we compared FLR-V...Background:We previously showed that embolization of portal inflow and hepatic vein(HV)outflow(liver venous deprivation,LVD)promotes future liver remnant(FLR)volume(FLR-V)and function(FLR-F)gain.Here,we compared FLR-V and FLR-F changes after portal vein embolization(PVE)and LVD.Methods:This study included all patients referred for liver preparation before major hepatectomy over 26 months.Exclusion criteria were:unavailable baseline/follow-up imaging,cirrhosis,Klatskin tumor,two-stage hepatectomy.99mTc-mebrofenin SPECT-CT was performed at baseline and at day 7,14 and 21 after PVE or LVD.FLR-V and FLR-F variations were compared using multivariate generalized linear mixed models(joint modelling)with/without missing data imputation.Results:Baseline FLR-F was lower in the LVD(n=29)than PVE group(n=22)(P<0.001).Technical success was 100%in both groups without any major complication.Changes in FLR-V at day 14 and 21(+14.2%vs.+50%,P=0.002;and+18.6%vs.+52.6%,P=0.001),and in FLR-F at day 7,14 and 21(+23.1%vs.+54.3%,P=0.02;+17.6%vs.+56.1%,P=0.006;and+29.8%vs.+63.9%,P<0.001)differed between PVE and LVD group.LVD(P=0.009),age(P=0.027)and baseline FLR-V(P=0.001)independently predicted FLR-V variations,whereas only LVD(P=0.01)predicted FLR-F changes.After missing data handling,LVD remained an independent predictor of FLR-V and FLR-F variations.Conclusions:LVD is safe and provides greater FLR-V and FLR-F increase than PVE.These results are now evaluated in the HYPERLIV-01 multicenter randomized trial.展开更多
文摘Background:We previously showed that embolization of portal inflow and hepatic vein(HV)outflow(liver venous deprivation,LVD)promotes future liver remnant(FLR)volume(FLR-V)and function(FLR-F)gain.Here,we compared FLR-V and FLR-F changes after portal vein embolization(PVE)and LVD.Methods:This study included all patients referred for liver preparation before major hepatectomy over 26 months.Exclusion criteria were:unavailable baseline/follow-up imaging,cirrhosis,Klatskin tumor,two-stage hepatectomy.99mTc-mebrofenin SPECT-CT was performed at baseline and at day 7,14 and 21 after PVE or LVD.FLR-V and FLR-F variations were compared using multivariate generalized linear mixed models(joint modelling)with/without missing data imputation.Results:Baseline FLR-F was lower in the LVD(n=29)than PVE group(n=22)(P<0.001).Technical success was 100%in both groups without any major complication.Changes in FLR-V at day 14 and 21(+14.2%vs.+50%,P=0.002;and+18.6%vs.+52.6%,P=0.001),and in FLR-F at day 7,14 and 21(+23.1%vs.+54.3%,P=0.02;+17.6%vs.+56.1%,P=0.006;and+29.8%vs.+63.9%,P<0.001)differed between PVE and LVD group.LVD(P=0.009),age(P=0.027)and baseline FLR-V(P=0.001)independently predicted FLR-V variations,whereas only LVD(P=0.01)predicted FLR-F changes.After missing data handling,LVD remained an independent predictor of FLR-V and FLR-F variations.Conclusions:LVD is safe and provides greater FLR-V and FLR-F increase than PVE.These results are now evaluated in the HYPERLIV-01 multicenter randomized trial.
