title: Posthepatectomy portal vein pressure predicts liver failure and mortality after major liver resection on noncirrhotic liver.
abstract: OBJECTIVE
  To evaluate the predictive value of portal vein pressure (PVP) after major liver resection for posthepatectomy liver failure (PLF) and 90-day mortality in patients without cirrhosis.
  
  
  BACKGROUND
  As elevated PVP is associated with liver failure after living donor liver transplantation, we hypothesized that the outcome after major hepatectomy may be influenced by posthepatectomy PVP.
  
  
  METHODS
  All patients without severe fibrosis or cirrhosis who underwent a major liver resection (≥3 segments) with an intraoperative measurement of PVP at the end of the procedure were included. Outcome was analyzed regarding 3 most widely used definitions of PLF: "50-50" criteria, peak of serum bilirubin greater than 120 μmol/L, and grade C PLF proposed by the International Study Group of Liver Surgery (ISGLS). Receiver operating characteristic curves and logistic regression model were used to determine the optimal cutoff of PVP and independent risk factors of PLF.
  
  
  RESULTS
  The study population consisted of 277 patients. Posthepatectomy PVP was gradually correlated with the PLF risk. Probability for PLF was nil when PVP was 10 mm Hg or less, ranges from 13% to 16%, depending on PLF definitions, when PVP was 20 mm Hg, and from 24% to 33% when PVP was 30 mm Hg. The optimal value of posthepatectomy PVP to predict PLF was 22 mm Hg when considering the "50-50" criteria and grade C PLF (proposed by the International Study Group of Liver Surgery). A value of 21 mm Hg best predicted PLF defined by peak of serum bilirubin greater than 120 μmol/L and 90-day mortality. At multivariate analysis, posthepatectomy PVP remained an independent predictor of PLF as well as the extent of resection, intraoperative transfusion, and the presence of diabetes. The 90-day mortality was associated with PVP greater than 21 mm Hg, older than 70 years, and intraoperative transfusion.
  
  
  CONCLUSIONS
  Posthepatectomy PVP is an independent predictive factor of PLF and of 90-day mortality after major liver resection in patients without cirrhosis. Intraoperative modulation of PVP would be advisable when PVP exceeds 20 mm Hg.
authors.affiliation: *AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France †Université Paris-Sud, Villejuif, France ‡Inserm, Unité 785, Villejuif, France §Inserm, Unité 776, Villejuif, France.
authors.forename: Marc-Antoine
authors.initials: MA
authors.lastname: Allard
authors.forename: René
authors.initials: R
authors.lastname: Adam
authors.forename: Pétru-Octav
authors.initials: PO
authors.lastname: Bucur
authors.forename: Salah
authors.initials: S
authors.lastname: Termos
authors.forename: Antonio Sa
authors.initials: AS
authors.lastname: Cunha
authors.forename: Henri
authors.initials: H
authors.lastname: Bismuth
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
mesh_terms: D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D017093:Liver Failure / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D016896:Treatment Outcome