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Hyperbilirubinemia does not impair induced liver hypertrophy after portal vein Embolization—a retrospective scandinavian cohort study

Björk, Dennis ; Carling, Ulrik ; Gilg, Stefan ; Hasselgren, Kristina ; Larsen, Peter N. ; Lindell, Gert LU ; Røsok, Bård I. ; Sandström, Per ; Sturesson, Christian LU and Tschuor, Christoph , et al. (2025) In European Journal of Surgical Oncology 51(7).
Abstract

Background: Portal vein embolization (PVE) may be used to induce hypertrophy of the future liver remnant (FLR) before major hepatectomy. The influence of hyperbilirubinemia on FLR hypertrophy after PVE is controversial. The aim of this study was to compare FLR hypertrophy after PVE between patients with and without elevated P-bilirubin. Materials/methods: This is a Scandinavian retrospective cohort study of patients from five hepatobiliary centres. This study included patients who underwent right-sided PVE from 2013 to 2023. Data were collected from electronic medical records. FLR growth was analysed with respect to normal or elevated P-bilirubin. Results: In total, 410 patients were included in this study. Among the total cohort, 105... (More)

Background: Portal vein embolization (PVE) may be used to induce hypertrophy of the future liver remnant (FLR) before major hepatectomy. The influence of hyperbilirubinemia on FLR hypertrophy after PVE is controversial. The aim of this study was to compare FLR hypertrophy after PVE between patients with and without elevated P-bilirubin. Materials/methods: This is a Scandinavian retrospective cohort study of patients from five hepatobiliary centres. This study included patients who underwent right-sided PVE from 2013 to 2023. Data were collected from electronic medical records. FLR growth was analysed with respect to normal or elevated P-bilirubin. Results: In total, 410 patients were included in this study. Among the total cohort, 105 patients had elevated P-bilirubin levels (≥26 μmol/L) at the time of PVE. Elevated P-bilirubin levels were not associated with impaired FLR hypertrophy after PVE, as determined by absolute growth (p < 0.001), relative growth (p = 0.008), degree of hypertrophy (p < 0.001) and kinetic growth rate (p = 0.002). Multivariable analysis revealed that elevated P-bilirubin levels at the time of PVE (p = 0.002) together with the use of N-butyl cyanoacrylate (NBCA) as an embolizing material (p = 0.009) were associated with increased FLR hypertrophy. A larger estimated total liver volume was associated with reduced FLR hypertrophy (p < 0.001). Conclusion: In this multicentre, retrospective cohort study, we were unable to show any negative effect of elevated P-bilirubin on FLR hypertrophy at the time of PVE. There is no need for P-bilirubin levels to normalize before PVE. This study supports the ongoing shift towards NBCA as an embolizing material.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Surgical Oncology
volume
51
issue
7
article number
109995
publisher
Elsevier
external identifiers
  • pmid:40147207
  • scopus:105001009283
ISSN
0748-7983
DOI
10.1016/j.ejso.2025.109995
language
English
LU publication?
yes
id
9b172f53-5216-4958-a397-6e0376bc1e0a
date added to LUP
2025-08-08 09:09:15
date last changed
2025-08-22 10:21:25
@article{9b172f53-5216-4958-a397-6e0376bc1e0a,
  abstract     = {{<p>Background: Portal vein embolization (PVE) may be used to induce hypertrophy of the future liver remnant (FLR) before major hepatectomy. The influence of hyperbilirubinemia on FLR hypertrophy after PVE is controversial. The aim of this study was to compare FLR hypertrophy after PVE between patients with and without elevated P-bilirubin. Materials/methods: This is a Scandinavian retrospective cohort study of patients from five hepatobiliary centres. This study included patients who underwent right-sided PVE from 2013 to 2023. Data were collected from electronic medical records. FLR growth was analysed with respect to normal or elevated P-bilirubin. Results: In total, 410 patients were included in this study. Among the total cohort, 105 patients had elevated P-bilirubin levels (≥26 μmol/L) at the time of PVE. Elevated P-bilirubin levels were not associated with impaired FLR hypertrophy after PVE, as determined by absolute growth (p &lt; 0.001), relative growth (p = 0.008), degree of hypertrophy (p &lt; 0.001) and kinetic growth rate (p = 0.002). Multivariable analysis revealed that elevated P-bilirubin levels at the time of PVE (p = 0.002) together with the use of N-butyl cyanoacrylate (NBCA) as an embolizing material (p = 0.009) were associated with increased FLR hypertrophy. A larger estimated total liver volume was associated with reduced FLR hypertrophy (p &lt; 0.001). Conclusion: In this multicentre, retrospective cohort study, we were unable to show any negative effect of elevated P-bilirubin on FLR hypertrophy at the time of PVE. There is no need for P-bilirubin levels to normalize before PVE. This study supports the ongoing shift towards NBCA as an embolizing material.</p>}},
  author       = {{Björk, Dennis and Carling, Ulrik and Gilg, Stefan and Hasselgren, Kristina and Larsen, Peter N. and Lindell, Gert and Røsok, Bård I. and Sandström, Per and Sturesson, Christian and Tschuor, Christoph and Sparrelid, Ernesto and Björnsson, Bergthor}},
  issn         = {{0748-7983}},
  language     = {{eng}},
  number       = {{7}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Surgical Oncology}},
  title        = {{Hyperbilirubinemia does not impair induced liver hypertrophy after portal vein Embolization—a retrospective scandinavian cohort study}},
  url          = {{http://dx.doi.org/10.1016/j.ejso.2025.109995}},
  doi          = {{10.1016/j.ejso.2025.109995}},
  volume       = {{51}},
  year         = {{2025}},
}