Is the liver kinetic growth rate in ALPPS unprecedented when compared with PVE and living donor liver transplant? A multicentre analysis.
BACKGROUND
The clinical perspective on hepatic growth is limited. The goal of the present study was to compare hepatic hypertrophy and the kinetic growth rate(KGR) in patients after the ALPPS (Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy) procedure, portal vein embolization (PVE) and living donor liver transplantation.


METHODS
Volumetry and KGR of the future liver remnant (FLR) were compared from (15) patients undergoing ALPPS, (53) patients undergoing PVE, (90) recipients of living donor liver grafts and (93) donors of living donor liver grafts.


RESULTS
The degree of hypertrophy was significantly greater after ALPPS (84.3 ± 7.8%) than after PVE (36.0 ± 27.2%) (P < 0.001). The KGR was also significantly greater for ALPPS [32.7 ± 13.6 cubic centimetres (cc)/day] (10.8 ± 4.5%/day) compared with PVE (4.4 ± 3.2 cc/day) (0.98 ± 0.75%/day) (P < 0.001). The FLR of living donor donors had the greatest degree of hypertrophy (107.5 ± 39.2%) and was greater than after ALPPS (P = 0.02), PVE (P < 0.001) and in living donor-recipient grafts (P < 0.001). KGR (cc/day) was greater in FLR of living donor donors compared with both ALPPS (P < 0.001) and PVE (P < 0.001). The KGR in patients undergoing ALPPS and living donor liver transplantation had a linear relationship with the size of FLR.


CONCLUSIONS
FLR hypertrophy and KGR were greater after ALPPS than PVE. However, the degree of hypertrophy after ALPPS is not unprecedented, as KGR in the FLR from living donor donors is equal to or greater than after ALPPS. The KGR of the FLR in patients after ALPPS and living donor donors correlates directly with the size of the FLR.
Divisions of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN, USA.|Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA.
Kristopher P
KP
Croome
Department of Surgery, Hepatobiliary Surgery Western University, London, ON, Canada.
Roberto
R
Hernandez-Alejandro
Divisions of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN, USA.
Maile
M
Parker
Division of Transplantation Surgery and Mayo Clinic William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN, USA.
Julie
J
Heimbach
Division of Transplantation Surgery and Mayo Clinic William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN, USA.
Charles
C
Rosen
Divisions of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN, USA.
David M
DM
Nagorney
D000328:Adult; D000368:Aged; D049109:Cell Proliferation; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007700:Kinetics; D008026:Ligation; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009864:Ontario; D009929:Organ Size; D011169:Portal Vein / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome