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J Gastrointest Surg. 2018 Feb;22(2):203-213. doi: 10.1007/s11605-017-3512-0. Epub 2017 Aug 1.

Rapid Liver Hypertrophy After Portal Vein Occlusion Correlates with the Degree of Collateralization Between Lobes-a Study in Pigs.

Author information

1
Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653, W. Congress Pkwy Jelke Building 7th Floor, Chicago, IL, 60612, USA.
2
Department of Experimental Surgery, Academic Medical Center, Amsterdam, The Netherlands.
3
Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland.
4
Department of Surgery - Transplant Surgery, Rush University Medical Center, 1653, W. Congress Pkwy Jelke Building 7th Floor, Chicago, IL, 60612, USA. erik.schadde@uzh.ch.
5
Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland. erik.schadde@uzh.ch.
6
Cantonal Hospital Winterthur, Brauerstr. 15, 8401, Winterthur, Kanton Zurich, Switzerland. erik.schadde@uzh.ch.

Abstract

BACKGROUND:

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) induces more rapid liver growth than portal vein ligation (PVL). Transection of parenchyma in ALPPS may prevent the formation of collaterals between lobes. The aim of this study was to determine if abrogating the formation of collaterals through parenchymal transection impacted growth rate.

METHODS:

Twelve Yorkshire Landrace pigs were randomized to undergo ALPPS, PVL, or "partial ALPPS" by varying degrees of parenchymal transection. Hepatic volume was measured after 7 days. Portal blood flow and pressure were measured. Portal vein collaterals were examined from epoxy casts.

RESULTS:

PVL, ALPPS, and partial ALPPS led to volume increases of the RLL by 15.5% (range 3-22), 64% (range 45-76), and 32% (range 18-77), respectively, with significant differences between PVL and ALPPS/partial ALPPS (p < 0.05). In PVL and partial ALPPS, substantial new portal vein collaterals were found. The number of collaterals correlated inversely with the growth rate (p = 0.039). Portal vein pressure was elevated in all models after ligation suggesting hyperflow to the portal vein-supplied lobe (p < 0.05).

CONCLUSIONS:

These data suggest that liver hypertrophy following PVL is inversely proportional to the development of collaterals. Hypertrophy after ALPPS is likely more rapid due to reduction of collaterals through transection.

KEYWORDS:

ALPPS; Liver regeneration; Pig model; Portal vein ligation

PMID:
28766271
DOI:
10.1007/s11605-017-3512-0
[Indexed for MEDLINE]

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