Christopher W Mangieri, MD, Jason C McCartt, MD, Matthew A Strode, DO, John E Lowry, DVM, Prasad M Balakrishna, PhD. Dwight D. Eisenhower Army Medical Center
Background: It is ideal to treat hepatic tumors with primary resection versus transplantation. A clinical adjunct to facilitating primary resection is portal vein embolization (PVE). Hepatic tumors that are too large for initial primary resection undergo PVE to induce hypertrophy of the liver that will not be resected allowing for sufficient post-operative liver volumes. Hepatocyte growth factor (HGF) is one of the strongest trophic factors for hepatocyte regeneration. The purpose of this study was to increase liver volumes with perioperative HGF infusions in an animal model that mimics PVE.
Methods: Portal branch ligation (PBL) in rodents is equivalent to the clinical practice of PVE in humans. We performed left-sided PBL in Sprague-Dawley rats with the control group receiving normal saline infusions and the experimental group receiving HGF infusions. Prior to performing PBL we established baseline liver volumetrics with CT scanning methods. We then repeated CT liver volumetrics following PBL to observe for differences in post-PBL liver volumes.
Results: The control and experimental rats had identical baseline liver volumetrics. The experimental rats undergoing perioperative HGF infusions had statistically significant increases in all post-operative liver volumetrics. Most clinically relevant were increased right liver volumes (RLV), 14.10 cm3 versus 7.85 cm3 (p value 0.0001), and increased degree hypertrophy (DH%), 159.23% versus 47.11% (p value 0.0079), in the remaining viable liver.
Conclusion: Perioperative HGF infusions significantly increase hepatic regeneration following PBL. HGF infusions following PVE is a possible adjunct to increase the amount of patients able to successfully undergo a primary liver resection. Future basic science is warranted in examining the use of HGF in that regard and potentially translating that basic science work to clinical practice.