Dong Yawen, Gregory Lindsey A, Podrascanin Vanja, Santol Jonas, Ammann Markus, Pereyra David, Hackl Hubert, Li Zhihao, Starlinger Johannes, Truty Mark J, Warner Susanne G, Smoot Rory L, Gruenberger Thomas, Nagorney David M, Starlinger Patrick P
Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Surgery, HPB Center, Vienna Health Network, Clinic Favoriten and Sigmund Freud Private University, Vienna, Austria.
Liver Transpl. 2025 Jul 4. doi: 10.1097/LVT.0000000000000676.
Portal hypertension is a key factor in posthepatectomy liver failure (PHLF). While preoperative liver function tests like APRI+ALBI assess liver function, they only partially reflect portal hypertension severity. Elevated von Willebrand factor antigen (vWF-Ag) indicates endothelial dysregulation and correlates with portal hypertension. Combining vWF-Ag with APRI+ALBI may enhance PHLF prediction. A total of 534 patients who underwent liver resection at Mayo Clinic Rochester (2020-2024) were analyzed for PHLF incidence, postoperative morbidity, and 90-day mortality. Predictive probability for PHLF was assessed using receiver operating characteristic analysis and validated in an external Austrian cohort of 283 patients (2008-2017). vWF-Ag was then integrated into the existing APRI+ALBI multivariable model. PHLF grade B/C was reported in 56 patients (10.5%). The 90-day mortality rate was 0.9% (n=5). Using 2 cutoffs (182%, 240%), vWF-Ag was found to be an independent predictive factor for PHLF grade B/C that remained statistically significant upon multivariable analysis. The combination of preoperative APRI+ALBI and vWF-Ag increased the positive predictive value to 27.9% for PHLF grade B/C in the APRI+ALBI high and vWF-Ag high group. Incorporation of vWF-Ag into the established APRI+ALBI-based multivariable model revealed a superior AUC of 0.772 for PHLF risk stratification and was successfully validated in an independent cohort (AUC=0.834). The combination of vWF-Ag with APRI+ALBI demonstrates a favorable predictive potential for PHLF risk assessment. We provide 2 pathways for clinical assessment: (1) a cutoff-based system and (2) a more complex multivariable model that can be calculated in a specifically designed smartphone application.
门静脉高压是肝切除术后肝功能衰竭（PHLF）的关键因素。虽然术前肝功能检查如APRI+ALBI可评估肝功能，但它们仅部分反映门静脉高压的严重程度。血管性血友病因子抗原（vWF-Ag）升高表明内皮细胞功能失调，且与门静脉高压相关。将vWF-Ag与APRI+ALBI相结合可能会增强对PHLF的预测能力。对梅奥诊所罗切斯特分院（2020年至2024年）接受肝切除术的534例患者进行了PHLF发生率、术后发病率和90天死亡率分析。使用受试者工作特征分析评估PHLF的预测概率，并在奥地利一个283例患者的外部队列（2008年至2017年）中进行验证。然后将vWF-Ag纳入现有的APRI+ALBI多变量模型。56例患者（10.5%）报告为PHLF B/C级。90天死亡率为0.9%（n=5）。使用两个临界值（182%，240%），发现vWF-Ag是PHLF B/C级的独立预测因素，在多变量分析中仍具有统计学意义。术前APRI+ALBI与vWF-Ag的组合使APRI+ALBI高且vWF-Ag高组中PHLF B/C级的阳性预测值提高到27.9%。将vWF-Ag纳入已建立的基于APRI+ALBI的多变量模型显示，PHLF风险分层的AUC为0.772，具有优越性，并在独立队列中成功验证（AUC=0.834）。vWF-Ag与APRI+ALBI的组合在PHLF风险评估中显示出良好的预测潜力。我们提供了两条临床评估途径：（1）基于临界值的系统和（2）一种更复杂的多变量模型，可在专门设计的智能手机应用程序中进行计算。
