Experimental and clinical studies on liver regeneration following transcatheter portal embolization

BACKGROUND/AIMS: We studied compensatory hypertrophy following transcathete r portal embolization experimentally in dogs and clinically under the condi tion of cholestasis. METHODOLOGY: Experimental study: Sixteen dogs were used for this study. Tra nscatheter portal embolization was performed in the left lobes (70% of the total liver) using Gelfoam powder in dogs with 2-week obstructive jaundice. Liver weight, liver blood flow and the intracellular adenosine triphospate content of isolated hepatocytes were measured after transcatheter portal e mbolization. Clinical Study: transcatheter portal embolization of the right port;al branch was performed in 13 patients with cancer of the biliary tra ct and 3 patients with hepatocellular carcinoma before (extended) right lob ectomy, using Gelfoam powder and thrombin. Six patients who had a total bil irubin level >5mg/dLunderwent a percutaneous transhepatic biliary drainage before transcatheter portal embolization. Liver function tests, a volumetri c study with computed tomography and immunohistochemical staining for profi lerating cell nuclear antigen and apoptosis in the resected livers were per formed. RESULTS: Experimental study: The weight ratio of the non-embolized lobes to the total liver, 2 weeks after transcatheter portal embolization in the do gs with jaundice, was significantly lower than that of the normal dogs with transcatheter portal embolization (40.5+/-4.54% vs. 47.6+/-3.21%), but sig nificantly larger than that of the dogs without transcatheter portal emboli zation. The cellular adenosine triphospate content and tissue blood flow in the embolized lobes were significantly lower than those in the nonembolize d lobes in the normal and cholestatic livers. Clinical study;: The postoper ative course in all patients was uneventful, with no serious complication o r liver dysfunction. Extended right lobectomy with caudate lobectomy was eq uivalent to 65% before transcatheter portal embolization and to 56% after, transcatheter portal embolization owing to compensatory hypertrophy of the left lobe. However, there was no significant difference in liver volume in the patients with or without obstructive jaundice. Apoptosis was observed i n the embolized lobe. CONCLUSIONS: Preoperative transcatheter portal embolization with percutaneo us transhepatic biliary drainage for the purpose of liver regeneration woul d be useful for treating extended hepatectomy with obstructive jaundice.