title: Preconditioning by portal vein embolization modulates hepatic hemodynamics and improves liver function in pigs with extended hepatectomy.
abstract: Portal vein embolization is performed weeks before extended hepatic resections to increase the future liver remnant and prevent posthepatectomy liver failure. Portal vein embolization performed closer to the operation also could be protective, but worsening of portal hyper-perfusion is a major concern. We determined the hepatic hemodynamic effects of a portal vein embolization performed 24 hours prior to hepatic operation.
  
  
  
  An extended (90%) hepatectomy was performed in swine undergoing (portal vein embolization) or not undergoing (control) a portal vein embolization 24 hours earlier (n = 10/group). Blood tests, hepatic and systemic hemodynamics, hepatic function (plasma disappearance rate of indocyanine green), liver histology, and volumetry (computed tomographic scanning) were assessed before and after the hepatectomy. Hepatocyte proliferating cell nuclear antigen expression and hepatic gene expression also were evaluated.
  
  
  
  Swine in the control and portal vein embolization groups maintained stable systemic hemodynamics and developed similar increases of portal blood flow (302 ± 72% vs 486 ± 92%, P = .13). Portal pressure drastically increased in Controls (from 9.4 ± 1.3 mm Hg to 20.9 ± 1.4 mm Hg, P < .001), while being markedly attenuated in the portal vein embolization group (from 11.4 ± 1.5 mm Hg to 16.1 ± 1.3 mm Hg, P = .061). The procedure also improved the preservation of the hepatic artery blood flow, liver function, and periportal edema. These effects occurred in the absence of hepatocyte proliferation or hepatic growth and were associated with the induction of the vasoprotective gene Klf2.
  
  
  
  Portal vein embolization preconditioning represents a potential hepato-protective strategy for extended hepatic resections. Further preclinical studies should assess its medium-term effects, including survival. Our study also supports the relevance of hepatic hemodynamics as the main pathogenetic factor of post-hepatectomy liver failure.
authors.affiliation: Servicio de Cirugía General III, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Facultad de Medicina, Univ. Complutense de Madrid, Madrid, Spain. Electronic address: jmasencio@gmail.com.
authors.forename: José M
authors.initials: JM
authors.lastname: Asencio
authors.affiliation: Servicio de Cirugía General III, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Facultad de Medicina, Univ. Complutense de Madrid, Madrid, Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: García-Sabrido
authors.affiliation: Servicio de Cirugía General III, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Facultad de Medicina, Univ. Complutense de Madrid, Madrid, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: López-Baena
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Olmedilla
authors.affiliation: Servicio de Anatomía Patológica, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Peligros
authors.affiliation: Servicio de Cirugía General III, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Lozano
authors.affiliation: Servicio de Cirugía General III, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Morales-Taboada
authors.affiliation: Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Fernández-Mena
authors.affiliation: Servicio de Cirugía General III, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Steiner
authors.affiliation: Servicio de Anatomía Patológica, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: Emma
authors.initials: E
authors.lastname: Sola
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Perez-Peña
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: Miriam
authors.initials: M
authors.lastname: Herrero
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Laso
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Lisbona
authors.affiliation: Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Facultad de Medicina, Univ. Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Casanova
authors.affiliation: Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Vaquero
mesh_terms: D000818:Animals; D001707:Biopsy, Needle; D004195:Disease Models, Animal; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D007150:Immunohistochemistry; D017093:Liver Failure / Q000473:pathology / Q000517:prevention & control*; D008111:Liver Function Tests; D008115:Liver Regeneration / Q000502:physiology*; D016343:Monitoring, Intraoperative / Q000379:methods; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000601:surgery; D011172:Portography / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011897:Random Allocation; D012016:Reference Values; D012307:Risk Factors; D013552:Swine; D014057:Tomography, X-Ray Computed / Q000379:methods