Allard et al correlated portal vein pressure and complications after major resection of noncirrhotic liver. This can help to identify a patient who may require more aggressive management. The authors are from Hopital Paul Brousse, Universite Paris-Sud and Inserm in Villejuif, France.
Patient selection: major resection (>= 3 segments) of noncirrhotic liver
Measurement: portal vein pressure (PVP) at the end of surgery
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PVP in mm Hg
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Risk Hepatic Failure
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<= 10 mm Hg
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0%
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20 mm Hg
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13-16%
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30 mm Hg
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24-33%
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Risk factors for post-hepatectomy liver failure:
(1) PVP >= 21 mm Hg (odds ratio 2.8), vs PVP > 22 mm Hg
(2) extent of resection with >= 5 segments (odds ratio 3.8)
(3) intraoperative transfusion (odds ratio 3.9)
(4) diabetes mellitus (odds ratio 8.7)
Risk factors for 90-day mortality:
(1) PVP >= 21 mm Hg (odds ratio 5.4)
(2) age >= 70 years (odds ratio 5.6)
(3) intraoperative transfusion (odds ratio 5.0)
Intraoperative modulation of portal vein pressure may improve outcomes.
