When is enough enough?-predicting adequacy of portal vein embolization for hypertrophy of the future liver…

Cohort studyHepatobiliary surgery and nutrition· Aug 2026

When is enough enough?-predicting adequacy of portal vein embolization for hypertrophy of the future liver remnant in the age of liver venous deprivation.

Antony Haddad, Reed I Ayabe, Andrew D Newton … Hop S Tran Cao

SurgeryCohort studyTreatment

Pre-embolization liver remnant volume strongly predicts adequate post-procedure liver regrowth.

When is enough enough?-predicting adequacy of portal vein embolization for hypertrophy of the future liver remnant in the age of liver venous deprivation.

Antony Haddad … Hop S Tran Cao

Hepatobiliary surgery and nutrition · Aug 2026

Background

Insufficient future liver remnant (future liver remnant) increases the risk of postoperative hepatic insufficiency and death.

Methods

Consecutive patients who underwent right portal vein embolization from January 1998 through December 2020 were identified.

n = 477 patients

Results

sFLR above 19% strongly predicts adequate regrowth, with 89% sensitivity and 75% specificity

OR 1.40 (95% CI 1.31 to 1.49)

CI excludes the null - significant

More results

The median (interquartile range) pre-portal vein embolization sFLR was 22% (16-29%).

Out of 477 patients, 284 (60%) achieved sFLR ≥30%, 271 (57%) achieved kinetic growth rate ≥2% per week, and 364 (76%) achieved at least one of the two.

More results

Multiple logistic regression showed that higher pre-portal vein embolization sFLR [odds ratio (OR), 1.4; 95% confidence interval (CI): 1.31-1.49] and extended portal vein embolization (OR, 0.47; 95% CI: 0.25-0.87) were predictive of post-portal vein embolization sFLR ≥30%.

“

Conclusion · 1 of 2

Patients with baseline sFLR <19% and those with baseline sFLR 19-26% and gross liver abnormalities or planned to undergo staged or extended right hepatectomy are unlikely to achieve adequate liver remnant hypertrophy with portal vein embolization.

Conclusion · 2 of 2

liver venous deprivation may be the preferred approach for these patients as it is known to induce augmented hypertrophy. Healthy weight maintenance should be encouraged after portal vein embolization to optimize liver regeneration.

When is enough enough?-predicting adequacy of portal vein embolization for hypertrophy of the future liver remnant in the age of liver venous deprivation.

When is enough enough?-predicting adequacy of portal vein embolization for hypertrophy of the future liver remnant in the age of liver venous deprivation.

Related papers