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Liver regeneration after performing associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) is histologically similar to that occurring after liver transplantation using a small-for-size graft

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Abstract

Purpose

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can achieve marked future liver remnant (FLR) hypertrophy but this procedure is associated with a risk of mortality due to liver failure because of an insufficient FLR functional increase, a situation comparable to small-for-size syndrome (SFSS) after living-donor liver transplantation (LDLT).

Methods

The clinical data, morphologic volume changes, and histopathologic and immunohistochemical findings in hepatocytes and bile ductules were compared between ALPPS (n = 10) and LDLT with a risk for SFSS (n = 12).

Results

Although the patient characteristics and short-term outcome differed between the groups, the mean hypertrophy ratios with respect to liver volume for the FLR after performing the first-stage ALPPS procedures resembled those in small-for-size grafts after similar time intervals: 1.702 ± 0.407 in ALPPS vs. 1.948 ± 0.252 in LDLT (P = 0.205). The histologic grades for sinusoidal dilation (P = 0.896), congestion (P = 0.922), vacuolar change (P = 0.964), hepatocanalicular cholestasis (P = 0.969), and ductular reaction (P = 0.728) within the FLR at the second-stage operation during ALPPS or implanted graft were all similar between the groups.

Conclusions

The hepatic regenerative process may be similar in ALPPS and LDLT using a small-for-size graft. Reducing the hepatic vascular inflow that may be excessive for the FLR volume during the first stage of ALPPS might enhance the functional recovery since measures with a similar effect appear to lessen the likelihood of SFSS.

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Abbreviations

ALPPS:

Associating liver partition and portal vein ligation for staged hepatectomy

CK:

Cytokeratin

CT:

Computed tomography

DAB:

Diaminobenzidine

FLR:

Future liver remnant

GRWR:

Graft-to-recipient weight ratio

HCV:

Hepatitis C virus

LDLT:

Living-donor liver transplantation

MDCT:

Multidetector computed tomography

PT-INR:

Prothrombin time international normalized ratio

SFSS:

Small-for-size syndrome

SLV:

Standard liver volume

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Authors and Affiliations

  1. Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan

    Tetsuji Wakabayashi, Kuniya Tanaka, Toshimitsu Shiozawa, Yuki Takahashi & Kenichi Matsuo

  2. Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Teikyo University Chiba Medical Center, Chiba, Japan

    Kuniya Tanaka & Kenichi Matsuo

  3. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan

    Kuniya Tanaka & Kenichi Matsuo

  4. Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan

    Mikiko Tanabe

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  1. Tetsuji Wakabayashi
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Correspondence to Kuniya Tanaka.

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Wakabayashi, T., Tanaka, K., Shiozawa, T. et al. Liver regeneration after performing associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) is histologically similar to that occurring after liver transplantation using a small-for-size graft. Surg Today 51, 374–383 (2021). https://doi.org/10.1007/s00595-020-02097-1

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