title: Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization-the effect of collaterals on embolized liver volume.
abstract: OBJECTIVE
  The purpose of this retrospective study was to monitor hypertrophy of future liver remnant following portal vein embolization (PVE) before planned extended right hepatectomy. However, because individual responses to PVE are highly variable, our focus was to identify cofactors of successful hypertrophy.
  
  
  METHODS
  28 patients with primary or secondary liver tumours, mean age 64.1 ± 12.9 years, underwent PVE. Volumetric analysis of hypertrophy before and after PVE (median 39.0 ± 15.7 days) was performed. The embolized liver segments were investigated for occurrence of reperfusion of their portal branches. Blood parameters before PVE were additionally investigated.
  
  
  RESULTS
  Patients were divided into responders (21/28) and non-responders (7/28) by post-PVE standardized future liver remnant being above or below 25%, respectively. No significant differences between the groups were found regarding biometric and volumetric parameters before PVE. In the entire group after PVE, the mean absolute increase of Segments 2 and 3 was 196.0 ± 84.7 cm3and the median relative increase was 46.6 ± 98.8%. The formation of left to right hepatic portoportal collaterals exhibited a negative correlation to successful hypertrophy (p = 0.004) as well as low plasma total protein (p = 0.019). Successful embolization of Segment IV showed only a trend to significance (p = 0.098).
  
  
  CONCLUSIONS
  Cofactors associated with a favourable outcome regarding hypertrophy were the absence of collaterals in the control CT scans and high plasma total protein. Advances in knowledge: Portoportal collaterals negatively influence hypertrophy after PVE. On the other hand, plasma total protein is a positive prognostic indicator on hypertrophy of the liver in our cohort.
authors.affiliation: 1 Institute of Radiology and Neuroradiology, Asklepios Hospital Barmbek, Hamburg, Germany.|2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany.
authors.forename: Martin
authors.identifier: http://orcid.org/0000-0002-3703-5763
authors.initials: M
authors.lastname: Zeile
authors.affiliation: 2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany.
authors.forename: Artur
authors.initials: A
authors.lastname: Bakal
authors.affiliation: 1 Institute of Radiology and Neuroradiology, Asklepios Hospital Barmbek, Hamburg, Germany.
authors.forename: Jan E
authors.initials: JE
authors.lastname: Volkmer
authors.affiliation: 2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany.|3 Department of Abdominal Surgery and Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany.
authors.forename: Gregor A
authors.initials: GA
authors.lastname: Stavrou
authors.affiliation: 2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany.|4 Department of Gastroenterology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Dautel
authors.affiliation: 1 Institute of Radiology and Neuroradiology, Asklepios Hospital Barmbek, Hamburg, Germany.|2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Hoeltje
authors.affiliation: 2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany.|5 Department of Oncology, Asklepios Hospital Barmbek, Hamburg, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Stang
authors.affiliation: 2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany.|3 Department of Abdominal Surgery and Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Oldhafer
authors.affiliation: 1 Institute of Radiology and Neuroradiology, Asklepios Hospital Barmbek, Hamburg, Germany.|2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Brüning
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D012189:Retrospective Studies