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

  • 2017 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

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.

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Acknowledgements

The authors acknowledge the extensive contributions of Karen Ohara to the organization and Diana Goldstein and Britanny Erdenberger to the performance of the animal experiments.

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Authors and Affiliations

  1. Department of Surgery – Transplant Surgery, Rush University Medical Center, 1653, W. Congress Pkwy Jelke Building 7th Floor, Chicago, IL, 60612, USA

    Rebecca Deal, Charles Frederiks, Lauren Williams, Xavier Keutgen, Edie Chan, Daniel Deziel, Martin Hertl & Erik Schadde

  2. Department of Experimental Surgery, Academic Medical Center, Amsterdam, The Netherlands

    Pim B. Olthof

  3. Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland

    Konstantin Dirscherl & Erik Schadde

  4. Cantonal Hospital Winterthur, Brauerstr. 15, 8401, Winterthur, Kanton Zurich, Switzerland

    Erik Schadde

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  1. Rebecca Deal
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  2. Charles Frederiks
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  3. Lauren Williams
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  4. Pim B. Olthof
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All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript.

Corresponding author

Correspondence to Erik Schadde.

Ethics declarations

Approval for the experiments was obtained from the Internal Animal Care and Use Committee (IACUC) of Rush University Medical Center. All experiments were performed in compliance with the “Guide for the care and use of laboratory animals” by the National Research Council, 2011 edition (https://www.nap.edu/download/12910) and the ARRIVE guidelines.

Financial Support

The authors have not received extramural support for this study.

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Deal, R., Frederiks, C., Williams, L. et al. Rapid Liver Hypertrophy After Portal Vein Occlusion Correlates with the Degree of Collateralization Between Lobes—a Study in Pigs. J Gastrointest Surg 22, 203–213 (2018). https://doi.org/10.1007/s11605-017-3512-0

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  • DOI: https://doi.org/10.1007/s11605-017-3512-0

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