Elsevier

Transplantation Proceedings

Volume 36, Issue 8, October 2004, Pages 2257-2260
Transplantation Proceedings

Functional hepatic regeneration following hepatectomy using galactosyl-human serum albumin liver scintigraphy

https://doi.org/10.1016/j.transproceed.2004.08.075Get rights and content

Abstract

In extended hepatectomy and liver transplantation, accurate estimation of functional hepatic regeneration is more important than volumetric regeneration. We investigated the usefulness of measuring the functional hepatic volume by 99m-technetium galactosyl-human serum albumin scintigraphy (GSA). Extended hepatectomy was performed in 32 patients. These patients were divided into subgroups with or without chronic hepatitis or cirrhosis. Functional hepatic volume GSA scintigraphy (GSA-LV) and determination of hepatic volume by CT (CT-LV) measurements were performed preoperatively, at 2 and 4 weeks and at 3 and 6 months after surgery. The preoperative GSA-LV values were significantly correlated with the hepatocyte volume and the 15-minute retention rate of indocyanine green (ICGR15). Similarly, the hepatocyte volume correlated well with the CT-LV and ICGR15. However, the CT-LV correlated only with the ICGR15. Recovery of the GSA-LV was delayed, and about 90% of the volumetric and functional regeneration was observed within 6 months after the hepatectomy. In contrast, the CT-LV in patients with normal liver remnants returned to approximately 90% of the initial volume within 1 month after the hepatectomy, whereas patients with injured livers regeneration showed gradual recovery to approximately 80% of the preoperative value by 6 months after hepatectomy. We conclude that measurement of functional hepatic volume using the GSA-LV is useful to evaluate hepatic function based on hepatocyte volume.

Section snippets

Clinical materials

The 32 patients included 20 hepatocellular carcinomas; six cholangiocarcinomas; four metastatic cancers; and two benign tumors. Twenty-two disegmentectomy and 10 trisegmentectomy procedures were performed. The mean age of the patients was 61 years, with a range of 49 to 71 years. There were 24 (75%) male and 8 (25%) female patients. Child's classification showed that 27 cases were Child A, and 5, Child B. The patients were then divided into two groups: normal liver (NOR) without chronic

Results

The preoperative GSA-LV values significantly correlated with hepatocyte volume, the ICGR15, and conventional liver function tests, such as aspartate aminotransferase, total protein, γ-glutamyl transpeptidase, γ-globulin, and activated partial thromboplastin time. Similarly, hepatocyte volume correlated with the CT-LV, the ICGR15, γ-globulin, prothrombin time, activated partial thromboplastin time, and the hepaplastin test. However, the CT-LV only correlated with the ICGR15. The preoperative

Discussion

Liver volume measurements obtained from computed tomograms have been used to extrapolate liver function.1, 2 However, liver volume measurements (CT-LV) obtained from our patients did not correlate with conventional indices of liver function, with the exception of the ICG test. The total hepatocyte volume significantly correlated with many parameters of liver function; higher correlation coefficients were demonstrated with this measurement than with the total liver volume. These results suggest

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