Increase of portal vein pressure gradient after hepatectomy predicts post-operative liver dysfunction

Abstract Background Post-hepatectomy liver failure (PHLF) is an important cause of mortality and morbidity. Whether Child–Pugh A Patients with varying degrees of cirrhosis are good candidates for hepatectomy is disputed. The purpose of this study was to analyse the impact of portal venous pressure gradient (PVPG) variation during surgery on PHLF. Methods PVPG, the pressure gradient between the portal vein and central vein, was measured in consecutive patients before and after liver resection. The optimal cut-off of PVGP to predict PHLF was determined by receiver operating characteristic (ROC) curve analysis. Risk factors for PHLF were subjected to univariable and multivariable analysis. Results Sixty Child-Pugh A patients were recruited. The mean PVPG was increased from 5.17 ± 4.78 millimeters of Mercury (mmHg) to 6.37 ± 4.44 mmHg after liver resection. The optimal cut-off value of PVPG increments to predict PHLF was 1.5 mmHg. Multivariable analysis showed prothrombin time (PT), post-hepatectomy PVPG increments of 1.5 mmHg or greater, and resected liver segments of 3 or more to be independent predictors of PHLF. Conclusions Acute PVPG increase after hepatectomy is associated with a higher risk of PHLF in Child-Pugh A patients.