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

• Published in: Journal of gastrointestinal surgery Vol. 22; no. 2; pp. 203 - 213
• Main Authors: Deal, Rebecca, Frederiks, Charles, Williams, Lauren, Olthof, Pim B., Dirscherl, Konstantin, Keutgen, Xavier, Chan, Edie, Deziel, Daniel, Hertl, Martin, Schadde, Erik
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2018; Springer Nature B.V
• Subjects: 2017 SSAT Plenary Presentation; Animals; Gastroenterology; Gastrointestinal surgery; Growth rate; Hepatectomy - methods; Hypertrophy; Ligation; Liver; Liver - anatomy & histology; Liver - physiology; Liver - surgery; Liver Circulation; Liver Regeneration; Medicine; Medicine & Public Health; Neovascularization, Physiologic; Organ Size; Portal Pressure; Portal Vein - surgery; Random Allocation; Surgery; Swine; Veins & arteries; Pig model; Liver regeneration; Portal vein ligation; ALPPS
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-017-3512-0

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.