Impact of CT-Assessed Liver Steatosis in Hepatic Regeneration and Surgical Outcome After Liver Venous Deprivation

Purpose: To evaluate the impact of CT-assessed liver steatosis (LS) on functional and volumetric hypertrophy in patients undergoing liver venous deprivation (LVD) prior major hepatectomy and surgical outcome. Materials and Methods: A single-center retrospective analysis was conducted on patients undergoing LVD between June 2019 and September 2024. LS was defined as mean liver density < 45HU on pre-LVD unenhanced CT-scan. Volumetric data, including future liver remnant (FLR), degree of hypertrophy (DH), kinetic growth rate (KGR = DH/week), and FLR increase, were collected at three different timepoints: i) pre-LVD, ii) at 0–15 days post-LVD (T1) and iii) at 15–30 days post-LVD (T2). Pre/post-procedural scintigraphy data and surgical outcome were collected. Results: Fifty-four patients (n = 16 LS; n = 38 non-LS) were included. LVD technical success was achieved in all procedures, without any major complications. The LS group showed significantly lower DH, KGR, and FLR volume increase at T1 and T2, respectively, 4.8 vs 7.7%, (p = 0.034), (3.89 vs 5%/week (p = 0.02), and 16.7% vs 25.4% (p = 0.048) at T1; 6.9% vs 11.9% (p = 0.022), 1.7%/week vs 3.5%/week (p = 0.001), and 26.4% vs 34.2% (p = 0.035) at T2. LS group demonstrated lower FLR function (%/min/m2) than non-LS both before (1.81 vs 2.03, p = 0.06) and after LVD (2.19 vs 3.2, p = 0.006), without difference in FLR function hypertrophy. LS patients needed longer time to undergo surgery (55 vs 38 days, p = 0.002), with fewer patients reaching planned surgery (9 vs 32, p = 0.028) and had more major complications. Conclusion: In this retrospective study, volumetric FLR increase was lower in LS than non-LS patients, with similar functional increase. CT-assessed LS may help identify low-responder patients prior to LVD.