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Hepatobiliary scintigraphy and kinetic growth rate predict liver failure after ALPPS : a multi-institutional study

Federico Tomassini, Yves D'Asseler (UGent) , Michael Linecker, Mariano C. Giglio, Carlos Castro-Benitez, Stéphanie Truant, Rimma Axelsson, Pim B. Olthof, Roberto Montalti, Matteo Serenari, et al.
(2020) HPB. 22(10). p.1420-1428
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Abstract
Background: Post hepatectomy liver failure (PHLF) after ALPPS has been related to the discrepancy between liver volume and function. Pre-operative hepatobiliary scintigraphy (HBS) can predict postoperative liver function and guide when it is safe to proceed with major hepatectomy. Aim of this study was to evaluate the role of HBS in predicting PHLF after ALPPS, defining a safe cut-off. Methods: A multicenter retrospective study was approved by the ALPPS Registry. All patients selected for ALPPS between 2012 and 2018, were evaluated. Every patient underwent HBS during ALPPS evaluation. PHLF was reported according to ISGLS definition, considering grade B or C as clinically significant. Results: 98 patients were included. Thirteen patients experienced PHLF grade B or C (14%) following ALPPS-2. The HBS and the daily gain in volume (KGRFLR) of the future liver remnant (FLR) were significantly lower in PHLF B and C (p = .004 and .041 respectively). ROC curves indicated safe cut-offs of 4.1%/day (AUC = 0.68) for KGRFLR, and of 2.7 %/min/m(2) (AUC = 0.75) for HBSFLR. Multivariate analysis confirmed these cut-offs as variables predicting PHLF after ALPPS-2. Conclusion: Patients presenting a KGRFLR <4.1%/day and a HBSFLR <2.7%/min/m(2) are at high risk of PHLF and their second stage should be re-discussed.
Keywords
Hepatology, Gastroenterology, PORTAL-VEIN LIGATION, HEPATECTOMY, PARTITION, REMNANT, VOLUME, MORTALITY, CLEARANCE, SAFETY

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MLA
Tomassini, Federico, et al. “Hepatobiliary Scintigraphy and Kinetic Growth Rate Predict Liver Failure after ALPPS : A Multi-Institutional Study.” HPB, vol. 22, no. 10, 2020, pp. 1420–28, doi:10.1016/j.hpb.2020.01.010.
APA
Tomassini, F., D’Asseler, Y., Linecker, M., Giglio, M. C., Castro-Benitez, C., Truant, S., … Troisi, R. I. (2020). Hepatobiliary scintigraphy and kinetic growth rate predict liver failure after ALPPS : a multi-institutional study. HPB, 22(10), 1420–1428. https://doi.org/10.1016/j.hpb.2020.01.010
Chicago author-date
Tomassini, Federico, Yves D’Asseler, Michael Linecker, Mariano C. Giglio, Carlos Castro-Benitez, Stéphanie Truant, Rimma Axelsson, et al. 2020. “Hepatobiliary Scintigraphy and Kinetic Growth Rate Predict Liver Failure after ALPPS : A Multi-Institutional Study.” HPB 22 (10): 1420–28. https://doi.org/10.1016/j.hpb.2020.01.010.
Chicago author-date (all authors)
Tomassini, Federico, Yves D’Asseler, Michael Linecker, Mariano C. Giglio, Carlos Castro-Benitez, Stéphanie Truant, Rimma Axelsson, Pim B. Olthof, Roberto Montalti, Matteo Serenari, Thiery Chapelle, Valerio Lucidi, Ernesto Sparrelid, René Adam, Thomas Van Gulik, François-René Pruvot, Pierre-Alain Clavien, Dario Bruzzese, Karen Geboes, and Roberto I. Troisi. 2020. “Hepatobiliary Scintigraphy and Kinetic Growth Rate Predict Liver Failure after ALPPS : A Multi-Institutional Study.” HPB 22 (10): 1420–1428. doi:10.1016/j.hpb.2020.01.010.
Vancouver
1.
Tomassini F, D’Asseler Y, Linecker M, Giglio MC, Castro-Benitez C, Truant S, et al. Hepatobiliary scintigraphy and kinetic growth rate predict liver failure after ALPPS : a multi-institutional study. HPB. 2020;22(10):1420–8.
IEEE
[1]
F. Tomassini et al., “Hepatobiliary scintigraphy and kinetic growth rate predict liver failure after ALPPS : a multi-institutional study,” HPB, vol. 22, no. 10, pp. 1420–1428, 2020.
@article{8674499,
  abstract     = {{Background: Post hepatectomy liver failure (PHLF) after ALPPS has been related to the discrepancy between liver volume and function. Pre-operative hepatobiliary scintigraphy (HBS) can predict postoperative liver function and guide when it is safe to proceed with major hepatectomy. Aim of this study was to evaluate the role of HBS in predicting PHLF after ALPPS, defining a safe cut-off.

Methods: A multicenter retrospective study was approved by the ALPPS Registry. All patients selected for ALPPS between 2012 and 2018, were evaluated. Every patient underwent HBS during ALPPS evaluation. PHLF was reported according to ISGLS definition, considering grade B or C as clinically significant.

Results: 98 patients were included. Thirteen patients experienced PHLF grade B or C (14%) following ALPPS-2. The HBS and the daily gain in volume (KGRFLR) of the future liver remnant (FLR) were significantly lower in PHLF B and C (p = .004 and .041 respectively). ROC curves indicated safe cut-offs of 4.1%/day (AUC = 0.68) for KGRFLR, and of 2.7 %/min/m(2) (AUC = 0.75) for HBSFLR. Multivariate analysis confirmed these cut-offs as variables predicting PHLF after ALPPS-2.

Conclusion: Patients presenting a KGRFLR <4.1%/day and a HBSFLR <2.7%/min/m(2) are at high risk of PHLF and their second stage should be re-discussed.}},
  author       = {{Tomassini, Federico and D'Asseler, Yves and Linecker, Michael and Giglio, Mariano C. and Castro-Benitez, Carlos and Truant, Stéphanie and Axelsson, Rimma and Olthof, Pim B. and Montalti, Roberto and Serenari, Matteo and Chapelle, Thiery and Lucidi, Valerio and Sparrelid, Ernesto and Adam, René and Van Gulik, Thomas and Pruvot, François-René and Clavien, Pierre-Alain and Bruzzese, Dario and Geboes, Karen and Troisi, Roberto I.}},
  issn         = {{1365-182X}},
  journal      = {{HPB}},
  keywords     = {{Hepatology,Gastroenterology,PORTAL-VEIN LIGATION,HEPATECTOMY,PARTITION,REMNANT,VOLUME,MORTALITY,CLEARANCE,SAFETY}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1420--1428}},
  title        = {{Hepatobiliary scintigraphy and kinetic growth rate predict liver failure after ALPPS : a multi-institutional study}},
  url          = {{http://doi.org/10.1016/j.hpb.2020.01.010}},
  volume       = {{22}},
  year         = {{2020}},
}
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