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A systematic review of the impact of portal vein pressure changes on clinical outcomes following hepatic resection

Lookup NU author(s): John Hammond

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Abstract

© 2020 International Hepato-Pancreato-Biliary Association Inc.Background: There are evolving data correlating elevated post-hepatic resection portal vein pressure (PVP) with risk of developing post-resection liver failure (PLF) and other complications. As a consequence, modulation of PVP presents a potential strategy to improve outcomes following liver resection (LR). The primary aim of this study was to review the existing evidence regarding the impact of post-resection PVP on clinical outcomes in patients undergoing a LR. Methods: Systematic literature searches of electronic databases in accordance with PRISMA were conducted. Changes in PVP and clinical outcomes following liver resection were defined according to the existing literature. Results: Ten studies, consisting of 712 patients with a median age 61 (52–68) years, were identified that met the inclusion criteria. Of those, 77% (n = 550) underwent a major LR and 27% (n = 195) of patients had cirrhosis. Following LR, the median (range) PVP increased from 11.4 mmHg (median baseline, range 7.3–16.4) to 15.9 mmHg (7.9–19). The overall median incidence of PLF was 19%. Six of the ten studies found an elevated PVP after LR predicted PLF. One study found elevated PVP after LR predicted mortality after LR. Conclusion: Elevated PVP following hepatic resection was associated with increased rates of PLF. It was not possible to define a specific threshold PVP for predicting PLF. Modulation of PVP therefore presents a potential strategy to mitigate the incidence of LR. Future studies should standardize on reporting liver remnant and haemodynamics to better characterize clinical outcomes following LR.

Publication metadata

Author(s): Gavriilidis P, Hammond JS, Hidalgo E

Publication type: Review

Publication status: Published

Journal: HPB

Year: 2020

Volume: 22

Issue: 11

Pages: 1521-1529

Print publication date: 01/11/2020

Online publication date: 10/08/2020

Acceptance date: 09/07/2020

ISSN (print): 1365-182X

ISSN (electronic): 1477-2574

Publisher: Elsevier B.V.

URL: https://doi.org/10.1016/j.hpb.2020.07.006

DOI: 10.1016/j.hpb.2020.07.006

PubMed id: 32792308

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