Liver Venous Deprivation (LVD) for Primarily Unresectable Liver Tumors Induces More Kinetic Liver Growth Than Portal Vein Embolization Alone

Background: The combination of portal and hepatic vein occlusion accelerates the growth of the future liver remnant in animal and human pilot studies. This study compares the kinetic growth rate observed after liver venous deprivation (LVD) with the gold standard portal vein embolization (PVE) to render primarily non-resectable liver tumors resectable in two European centers. Methods: Patients undergoing LVD and PVE from a Swiss and Spanish center recorded in a prospective registry were retrospectively reviewed. Primary endpoint was kinetic growth rate by standardized liver remnant volume (sFLR) and liver to body mass ratio (LBWR). Demographics, indications, and clinical outcomes were analyzed. Results: Between 03/2014–12/2018, 13 and 18 patients underwent LVD and PVE respectively. sFLR and LBWR were at a median of 0.26/0.58 for LVD and 0.23/0.48 for PVE prior to the intervention and 0.41/0.91 for LVD and 0.38/0.71 for PVE after the intervention, at a median of 20 (LVD) and 36 (PVE) days respectively. Kinetic growth rate of the sFLR was 0.08±0.04/week for LVD and 0.03±0.01/week for PVE (p<0.001). Median age was 54±13 and 61±10 years and tumor types were colorectal metastasis (CRLM) in 77% and 85% in LVD and PVE resp. One patient with intrahepatic cholangiocarcinoma (IHCC) died from infected tumor necrosis after LVD without achieving resection. Major complication rate (Dindo-Clavien>IIIA) after stage 2 resection was 15% and 11% in LVD and PVE resp. Conclusion: LVD accelerates kinetic growth of the FLR by a factor of 3. It should be cautioned against the use of LVD in large IHCC, but based on limited data. LVD should be studied prospectively and compared to the gold standard portal vein embolization. FLR volume change LVD vs. PVE