M. I. Orue-Echebarria1, P. Lozano1, J. López-Baena1, E. Vara2, L. Olmedilla3, C. J. Lisbona3, J. Vaquero4, J. García Sabrido1, J. Asencio1 1General University Hospital Gregorio Marañón,Department Of General And Digestive Surgery,Madrid, MADRID, Spain 2Complutense University,Department Biochemistry And Molecular Biology,Madrid, Spain 3General University Hospital Gregorio Marañon,Department Of Anesthesia,Madrid, Spain 4General University Hospital Gregorio Marañon,Laboratory In Hepatology,Madrid, Spain
Background: Portal vein embolization is usually 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.
Methods: A subtotal (90%) hepatectomy was performed in swine undergoing 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.
Result: 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.
Conclusion: Regenerative preconditioning by portal vein embolization represents a potential hepato-protective strategy for major hepatic resections.