Progressive liver disease after major liver surgery in a dog

Abstract

The consequences of large-volume hepatectomy on the remaining liver in the dog are not documented. This case report documents a progressive hepatopathy after central division hepatectomy in a 10-year-old female Lhasa Apso dog. Serum biochemistry at presentation for chronic urinary incontinence indicated a hepatopathy, with a liver mass identified on subsequent ultrasound. Referral for computed tomography (CT) (day 76) demonstrated a central division liver mass (~204cm). A central division hepatectomy (right medial and quadrate lobes; gallbladder) was performed, with microscopic examination confirming a hepatocellular carcinoma. Serial biochemistry over a three-and-a-half-year follow-up documented progressive hepatopathy. Serial CT hepatic volumetry (day 76, 136, 1041) documented gross enlargement of the residual right lateral liver lobe and gross reduction of the residual left medial and lateral liver lobes. Biopsies of the left and right liver (day 187) demonstrated disparate pathology with microscopic features consistent with regeneration in the right liver and elevated portal vein pressure (PVP) in the left liver. This report documents progressive hepatopathy evidenced by serum biochemistry, disparate and persistent gross liver changes on posthepatectomy CT, and microscopic changes consistent with elevated PVP. Findings from this case demonstrate similarities to posthepatectomy liver failure (PHLF) and small-for-size-and-flow syndrome (SFSS) as reported in people and animal models. The progressive hepatopathy posthepatectomy in this case prompts consideration and further investigation for the development of PHLF and SFSS in the dog.