title: Interstage Assessment of Remnant Liver Function in ALPPS Using Hepatobiliary Scintigraphy: Prediction of Posthepatectomy Liver Failure and Introduction of the HIBA Index.
abstract: The aim of this study was to evaluate interstage liver function in associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) using hepatobiliary scintigraphy (HBS) and whether this may help to predict posthepatectomy liver failure (PHLF).
  
  
  
  ALPPS remains controversial given the high rate of liver-related mortality after stage 2. HBS combined with single photon emission computed tomography (SPECT) accurately estimates future liver remnant function and may be useful to predict PHLF.
  
  
  
  Between 2011 and 2016, 20 of 39 patients (51.3%) underwent SPECT-HBS before ALPPS stage 2 for primary (n = 3) or secondary liver tumors (n = 17) at the Hospital Italiano de Buenos Aires (HIBA). PHLF was defined by the International Study Group of Liver Surgery criteria, 50-50 criteria, or peak bilirubin >7 mg/dL. Grade A PHLF was excluded, as it requires no change in clinical management. Receiver-operating characteristic curves were used to determine cutoff for HBS parameters.
  
  
  
  Interstagely, 3 HBS parameters differed significantly between patients with (n = 4) and without PHLF (n = 16) after stage 2. Among these, the HIBA-index best predicted PHLF, with a cutoff value of 15%. The risk of PHLF in patients with cutoff <15% was 80%, whereas no patient with cutoff ≥15% developed PHLF.
  
  
  
  Interstage HBS could help to predict clinically significant PHLF after ALPPS stage 2. An HIBA-index cutoff of 15% seemed to give the best diagnostic performance. Although further studies are needed to confirm our findings, the routine application of this noninvasive low-cost examination could facilitate decision-making in institutions performing ALPPS.
authors.affiliation: Department of Medical and Surgical Sciences, General Surgery and Transplantation Unit, University of Bologna, Italy.|Department of Surgery, Division of HPB Surgery, Liver Transplant Unit.
authors.forename: Matteo
authors.initials: M
authors.lastname: Serenari
authors.affiliation: Department of Nuclear Medicine.
authors.forename: Carlos
authors.initials: C
authors.lastname: Collaud
authors.affiliation: Department of Surgery, Division of HPB Surgery, Liver Transplant Unit.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Alvarez
authors.affiliation: Department of Surgery, Division of HPB Surgery, Liver Transplant Unit.
authors.forename: Martin
authors.initials: M
authors.lastname: de Santibañes
authors.affiliation: Clinical Research Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Diego
authors.initials: D
authors.lastname: Giunta
authors.affiliation: Department of Surgery, Division of HPB Surgery, Liver Transplant Unit.
authors.forename: Juan
authors.initials: J
authors.lastname: Pekolj
authors.affiliation: Department of Surgery, Division of HPB Surgery, Liver Transplant Unit.
authors.forename: Victoria
authors.initials: V
authors.lastname: Ardiles
authors.affiliation: Department of Surgery, Division of HPB Surgery, Liver Transplant Unit.
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
mesh_terms: D000368:Aged; D000814:Aniline Compounds; D005260:Female; D005998:Glycine; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007098:Imino Acids / Q000008:administration & dosage; D008099:Liver / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017093:Liver Failure / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D015609:Organotechnetium Compounds / Q000008:administration & dosage; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011183:Postoperative Complications; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D005998:Glycine