Introduction: Indocyanine green (ICG) clearance and remnant liver volume (RLV) are the two important factors in predicting post-hepatectomy liver failure (PHLF) after major hepatectomy; however, the combination of these is still controversial. This study is to find a way to combine these to select candidates for safe major hepatectomy.

Methods: A prospective cohort study included 137 major hepatectomies. ICG clearance (through ICG remnant at 15 minutes: ICG-R15), liver function results and the ratio of remnant to standard liver volume (RLV/SLV) were analyzed to examine their relations to PHLF. These variables, gender and age were analyzed using multivariate logistic regression to establish a model to predict PHLF.

Results: PHLF rate after major hepatectomy was 16.8% with 5.8% for grade B-C. ICG-R15 and RLV/SLV were significantly associated with PHLF (p = 0.019 and 0.007 respectively). ICG-R15 was not significantly associated with the grade of PHLF while RLV/SLV was but the post-hoc analysis showed no significant difference. Group RLV/SLV < 40% tended to have higher rate and grade of PHLF than group RLV/SLV > 40% but the difference was not significant (p = 0.063 and 0.072 respectively). Based on gender, age, ICG-R15 and RLV/SLV, PHLF rate could be estimated with model performance of 77%.

Conclusion: ICG clearance and RLV were associated with PHLF after major hepatectomy. It was safe and feasible to perform major hepatectomy with RLV/SLV under 40% and good ICG-R15. It was possible to estimate PHLF rate based on the patients’ gender, age, ICG-R15 and RLV/SLV. 

Introduction: Indocyanine green (ICG) clearance (through ICG retention rate at 15 minutes - ICG-R15) is proven to correlate with histological fibrosis stage. Child-Pugh score, although proven to have weaker correlation, is still one of pre-hepatectomy liver function assessments. This study is to compare ICG-R15 and Child-Pugh score in evaluation of histological fibrosis stage and predicting of post-hepatectomy liver failure (PHLF) and to create the model of staging estimation for fibrosis.

Methods: A prospective cohort study was conducted in 340 patients of hepatectomy. ICG-R15, Child-Pugh score and platelet count (PLT) were analyzed to examine their association with histological fibrosis stage and PHLF. Ordinal logistic regression was used to establish the model of staging estimation for fibrosis.

Results: Child-Pugh score showed no significant association with histological fibrosis stage (p = 0.257) while ICG-R15 had a weak correlation (r = 0.232, p < 0.001), INR had a weak correlation (r = 0.156, p = 0.004), PLT had a negative correlation (r = -0.378, p < 0.001). The histological fibrosis stage could be estimated based on gender, age, ICG-R15 and PLT with AUC of 0.68. ICG-R15 was shown to be related to PHLF (p = 0.039) in which non-PHLF group had 0.75 times lower ICG-R15 than PHLF group while Child-Pugh score was shown to be statistically insignificant.

Conclusion: ICG clearance test was better than Child-Pugh score in evaluation of pre-hepatectomy liver function and predicting of PHLF. It was possible to estimate the histological fibrosis stage based on gender, age, ICG-R15 and PLT. 

Type B Hepatic encephalopathy (HE) due to a congenital extra-hepatic porto-systemic shunt is an extremely rare condition. We report the case of a 57-year-old woman, with recurrent episodes of confusion and neuropsychiatric symptoms, who had an elevated serum ammonia level and a superior mesenteric-caval shunt documented on abdominal computed topography (CT) scan. There was no evidence of cirrhosis or portal hypertension. A diagnosis of non-cirrhotic, non-portal hypertension hepatic encephalopathy was made after excluding other causes of confusion and cognitive impairment. The patient was successfully treated by radiologically guided endovascular shunt closure and during 9 months follow up, her neuropsychiatric symptoms did not recur and repeated serum ammonia level results were normal.