Skip to main content
SpringerLink
Log in

Postoperative Liver Failure: Definitions, Risk factors, Prediction Models and Prevention Strategies

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Liver resection is the treatment for a variety of benign and malignant conditions. Despite advances in preoperative selection, surgical technique, and perioperative management, post hepatectomy liver failure (PHLF) is still a leading cause of morbidity and mortality following liver resection.

Methods

A review of the literature was performed utilizing MEDLINE/PubMed and Web of Science databases in May of 2023. The MESH terms “liver failure,” “liver insufficiency,” and “hepatic failure” in combination with “liver surgery,” “liver resection,” and “hepatectomy” were searched in the title and/or abstract. The references of relevant articles were reviewed to identify additional eligible publications.

Results

PHLF can have devastating physiological consequences. In general, risk factors can be categorized as patient-related, primary liver function-related, or perioperative factors. Currently, no effective treatment options are available and the management of PHLF is largely supportive. Therefore, identifying risk factors and preventative strategies for PHLF is paramount. Ensuring an adequate future liver remnant is important to mitigate risk of PHLF. Dynamic liver function tests provide more objective assessment of liver function based on the metabolic capacity of the liver and have the advantage of easy administration, low cost, and easy reproducibility.

Conclusion

Given the absence of randomized data specifically related to the management of PHLF, current strategies are based on the principles of management of acute liver failure from any cause. In addition, goal-directed therapy for organ dysfunction, as well as identification and treatment of reversible factors in the postoperative period are critical.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kauffmann R, Fong Y. Post-hepatectomy liver failure. Hepatobiliary Surg Nutr. 2014;3(5):238-46.

    PubMed  PubMed Central  Google Scholar 

  2. Hammond JS, Guha IN, Beckingham IJ, Lobo DN. Prediction, prevention and management of postresection liver failure. Br J Surg. 2011;98(9):1188-200.

    CAS  PubMed  Google Scholar 

  3. Vibert E, Pittau G, Gelli M, Cunha AS, Jamot L, Faivre J, et al. Actual incidence and long-term consequences of posthepatectomy liver failure after hepatectomy for colorectal liver metastases. Surgery. 2014;155(1):94-105.

    PubMed  Google Scholar 

  4. Sultana A, Brooke-Smith M, Ullah S, Figueras J, Rees M, Vauthey JN, et al. Prospective evaluation of the International Study Group for Liver Surgery definition of post hepatectomy liver failure after liver resection: an international multicentre study. HPB (Oxford). 2018;20(5):462-9.

    PubMed  Google Scholar 

  5. Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg. 2003;138(11):1198-206; discussion 206.

    PubMed  Google Scholar 

  6. Gong WF, Zhong JH, Lu Z, Zhang QM, Zhang ZY, Chen CZ, et al. Evaluation of liver regeneration and post-hepatectomy liver failure after hemihepatectomy in patients with hepatocellular carcinoma. Biosci Rep. 2019;39(8):BSR20190088.

  7. Gilg S, Sandström P, Rizell M, Lindell G, Ardnor B, Strömberg C, et al. The impact of post-hepatectomy liver failure on mortality: a population-based study. Scand J Gastroenterol. 2018;53(10-11):1335-9.

    PubMed  Google Scholar 

  8. van den Broek MA, Olde Damink SW, Dejong CH, Lang H, Malagó M, Jalan R, et al. Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int. 2008;28(6):767-80.

    PubMed  Google Scholar 

  9. Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg. 2004;240(4):698-708; discussion -10.

    PubMed  PubMed Central  Google Scholar 

  10. Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, et al. The "50-50 criteria" on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 2005;242(6):824-8, discussion 8-9.

    PubMed  PubMed Central  Google Scholar 

  11. Mullen JT, Ribero D, Reddy SK, Donadon M, Zorzi D, Gautam S, et al. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg. 2007;204(5):854-62; discussion 62-4.

    PubMed  Google Scholar 

  12. Rahbari NN, Reissfelder C, Koch M, Elbers H, Striebel F, Büchler MW, et al. The predictive value of postoperative clinical risk scores for outcome after hepatic resection: a validation analysis in 807 patients. Ann Surg Oncol. 2011;18(13):3640-9.

    PubMed  Google Scholar 

  13. Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149(5):713-24.

    PubMed  Google Scholar 

  14. Greco E, Nanji S, Bromberg IL, Shah S, Wei AC, Moulton CA, et al. Predictors of peri-opertative morbidity and liver dysfunction after hepatic resection in patients with chronic liver disease. HPB (Oxford). 2011;13(8):559-65.

    PubMed  PubMed Central  Google Scholar 

  15. Little SA, Jarnagin WR, DeMatteo RP, Blumgart LH, Fong Y. Diabetes is associated with increased perioperative mortality but equivalent long-term outcome after hepatic resection for colorectal cancer. J Gastrointest Surg. 2002;6(1):88-94.

    PubMed  Google Scholar 

  16. Huo TI, Lui WY, Huang YH, Chau GY, Wu JC, Lee PC, et al. Diabetes mellitus is a risk factor for hepatic decompensation in patients with hepatocellular carcinoma undergoing resection: a longitudinal study. Am J Gastroenterol. 2003;98(10):2293-8.

    PubMed  Google Scholar 

  17. Li Q, Wang Y, Ma T, Lv Y, Wu R. Clinical outcomes of patients with and without diabetes mellitus after hepatectomy: A systematic review and meta-analysis. PLoS One. 2017;12(2):e0171129.

    PubMed  PubMed Central  Google Scholar 

  18. Horiuchi T, Haruki K, Shiba H, Sakamoto T, Saito N, Shirai Y, et al. Assessment of Outcome of Hepatic Resection for Extremely Elderly Patients With a Hepatic Malignancy. Anticancer Res. 2019;39(9):5143-8.

    CAS  PubMed  Google Scholar 

  19. Galun D, Bogdanovic A, Zivanovic M, Zuvela M. Short- and Long-Term Outcomes After Hepatectomy in Elderly Patients with Hepatocellular Carcinoma: An Analysis of 229 Cases from a Developing Country. J Hepatocell Carcinoma. 2021;8:155-65.

    PubMed  PubMed Central  Google Scholar 

  20. Cho SW, Steel J, Tsung A, Marsh JW, Geller DA, Gamblin TC. Safety of liver resection in the elderly: how important is age? Ann Surg Oncol. 2011;18(4):1088-95.

    CAS  PubMed  Google Scholar 

  21. Gilg S, Sparrelid E, Isaksson B, Lundell L, Nowak G, Strömberg C. Mortality-related risk factors and long-term survival after 4460 liver resections in Sweden-a population-based study. Langenbecks Arch Surg. 2017;402(1):105-13.

    PubMed  Google Scholar 

  22. Riffat F, Chu F, Morris DL. Liver resection in octogenarians. HPB (Oxford). 2006;8(3):206-10.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Dedinská I, Laca L, Miklušica J, Palkoci B, Skálová P, Lauková S, et al. Complications of liver resection in geriatric patients. Ann Hepatol. 2017;16(1):149-56.

    PubMed  Google Scholar 

  24. Elfrink AKE, Kok NFM, den Dulk M, Buis CI, Kazemier G, Ijzermans JNM, et al. Short-term postoperative outcomes after liver resection in the elderly patient: a nationwide population-based study. HPB (Oxford). 2021;23(10):1506-17.

    PubMed  Google Scholar 

  25. Kooby DA, Stockman J, Ben-Porat L, Gonen M, Jarnagin WR, Dematteo RP, et al. Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg. 2003;237(6):860-9; discussion 9-70.

    PubMed  PubMed Central  Google Scholar 

  26. Melendez J, Ferri E, Zwillman M, Fischer M, DeMatteo R, Leung D, et al. Extended hepatic resection: a 6-year retrospective study of risk factors for perioperative mortality. J Am Coll Surg. 2001;192(1):47-53.

    CAS  PubMed  Google Scholar 

  27. Brooks AJ, Hammond JS, Girling K, Beckingham IJ. The effect of hepatic vascular inflow occlusion on liver tissue pH, carbon dioxide, and oxygen partial pressures: defining the optimal clamp/release regime for intermittent portal clamping. J Surg Res. 2007;141(2):247-51.

    PubMed  Google Scholar 

  28. Belghiti J, Noun R, Zante E, Ballet T, Sauvanet A. Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study. Ann Surg. 1996;224(2):155-61.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Belghiti J, Noun R, Malafosse R, Jagot P, Sauvanet A, Pierangeli F, et al. Continuous versus intermittent portal triad clamping for liver resection: a controlled study. Ann Surg. 1999;229(3):369-75.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Fujii Y, Shimada H, Endo I, Morioka D, Nagano Y, Miura Y, et al. Risk factors of posthepatectomy liver failure after portal vein embolization. J Hepatobiliary Pancreat Surg. 2003;10(3):226-32.

    PubMed  Google Scholar 

  31. Collaborators GC. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5(3):245-66.

    Google Scholar 

  32. Huang DQ, Terrault NA, Tacke F, Gluud LL, Arrese M, Bugianesi E, et al. Global epidemiology of cirrhosis — aetiology, trends and predictions. Nat Rev Gastroenterol Hepatol. 2023;20(6):388-98.

  33. Utsunomiya T, Shimada M, Kudo M, Ichida T, Matsui O, Izumi N, et al. A comparison of the surgical outcomes among patients with HBV-positive, HCV-positive, and non-B non-C hepatocellular carcinoma: a nationwide study of 11,950 patients. Ann Surg. 2015;261(3):513-20.

    PubMed  Google Scholar 

  34. Pellicoro A, Ramachandran P, Iredale JP, Fallowfield JA. Liver fibrosis and repair: immune regulation of wound healing in a solid organ. Nature Reviews Immunology. 2014;14(3):181-94.

    CAS  PubMed  Google Scholar 

  35. Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 2000;191(1):38-46.

    CAS  PubMed  Google Scholar 

  36. Reddy SK, Marsh JW, Varley PR, Mock BK, Chopra KB, Geller DA, et al. Underlying steatohepatitis, but not simple hepatic steatosis, increases morbidity after liver resection: a case-control study. Hepatology. 2012;56(6):2221-30.

    PubMed  Google Scholar 

  37. Vauthey JN, Pawlik TM, Ribero D, Wu TT, Zorzi D, Hoff PM, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol. 2006;24(13):2065-72.

    CAS  PubMed  Google Scholar 

  38. Robinson SM, Wilson CH, Burt AD, Manas DM, White SA. Chemotherapy-associated liver injury in patients with colorectal liver metastases: a systematic review and meta-analysis. Ann Surg Oncol. 2012;19(13):4287-99.

    PubMed  PubMed Central  Google Scholar 

  39. Olthof PB, Wiggers JK, Groot Koerkamp B, Coelen RJ, Allen PJ, Besselink MG, et al. Postoperative Liver Failure Risk Score: Identifying Patients with Resectable Perihilar Cholangiocarcinoma Who Can Benefit from Portal Vein Embolization. J Am Coll Surg. 2017;225(3):387-94.

    PubMed  Google Scholar 

  40. Sahara K, Merath K, Hyer JM, Paredes AZ, Tsilimigras DI, Mehta R, et al. Impact of Preoperative Cholangitis on Short-term Outcomes Among Patients Undergoing Liver Resection. J Gastrointest Surg. 2020;24(11):2508-16.

    PubMed  Google Scholar 

  41. Vauthey JN, Abdalla EK, Doherty DA, Gertsch P, Fenstermacher MJ, Loyer EM, et al. Body surface area and body weight predict total liver volume in Western adults. Liver Transpl. 2002;8(3):233-40.

    PubMed  Google Scholar 

  42. Kishi Y, Abdalla EK, Chun YS, Zorzi D, Madoff DC, Wallace MJ, et al. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg. 2009;250(4):540-8.

    PubMed  Google Scholar 

  43. Truant S, Oberlin O, Sergent G, Lebuffe G, Gambiez L, Ernst O, et al. Remnant liver volume to body weight ratio > or =0.5%: A new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg. 2007;204(1):22-33.

    PubMed  Google Scholar 

  44. Abdalla EK, Adam R, Bilchik AJ, Jaeck D, Vauthey JN, Mahvi D. Improving resectability of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol. 2006;13(10):1271-80.

    PubMed  Google Scholar 

  45. Zorzi D, Laurent A, Pawlik TM, Lauwers GY, Vauthey JN, Abdalla EK. Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg. 2007;94(3):274-86.

    CAS  PubMed  Google Scholar 

  46. Kokudo T, Hasegawa K, Shirata C, Tanimoto M, Ishizawa T, Kaneko J, et al. Assessment of Preoperative Liver Function for Surgical Decision Making in Patients with Hepatocellular Carcinoma. Liver Cancer. 2019;8(6):447-56.

    PubMed  PubMed Central  Google Scholar 

  47. Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015;33(6):550-8.

    PubMed  Google Scholar 

  48. Olthof PB, Tomassini F, Huespe PE, Truant S, Pruvot FR, Troisi RI, et al. Hepatobiliary scintigraphy to evaluate liver function in associating liver partition and portal vein ligation for staged hepatectomy: Liver volume overestimates liver function. Surgery. 2017;162(4):775-83.

    PubMed  Google Scholar 

  49. Cieslak KP, Runge JH, Heger M, Stoker J, Bennink RJ, van Gulik TM. New perspectives in the assessment of future remnant liver. Dig Surg. 2014;31(4-5):255-68.

    PubMed  Google Scholar 

  50. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646-9.

    CAS  PubMed  Google Scholar 

  51. Burkhart RA, Pawlik TM. Staging and Prognostic Models for Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma. Cancer Control. 2017;24(3):1073274817729235.

    PubMed  PubMed Central  Google Scholar 

  52. Nakahara H, Itamoto T, Katayama K, Ohdan H, Hino H, Ochi M, et al. Indication of hepatectomy for cirrhotic patients with hepatocellular carcinoma classified as Child-Pugh class B. World J Surg. 2005;29(6):734-8.

    PubMed  Google Scholar 

  53. Kuroda S, Tashiro H, Kobayashi T, Oshita A, Amano H, Ohdan H. Selection criteria for hepatectomy in patients with hepatocellular carcinoma classified as Child-Pugh class B. World J Surg. 2011;35(4):834-41.

    PubMed  Google Scholar 

  54. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31(4):864-71.

    CAS  PubMed  Google Scholar 

  55. Delis SG, Bakoyiannis A, Biliatis I, Athanassiou K, Tassopoulos N, Dervenis C. Model for end-stage liver disease (MELD). score, as a prognostic factor for postoperative morbidity and mortality in cirrhotic patients, undergoing hepatectomy for hepatocellular carcinoma. HPB (Oxford). 2009;11(4):351-7.

    PubMed  PubMed Central  Google Scholar 

  56. Teh SH, Sheppard BC, Schwartz J, Orloff SL. Model for End-stage Liver Disease score fails to predict perioperative outcome after hepatic resection for hepatocellular carcinoma in patients without cirrhosis. Am J Surg. 2008;195(5):697-701.

    PubMed  Google Scholar 

  57. Marasco G, Alemanni LV, Colecchia A, Festi D, Bazzoli F, Mazzella G, et al. Prognostic Value of the Albumin-Bilirubin Grade for the Prediction of Post-Hepatectomy Liver Failure: A Systematic Review and Meta-Analysis. J Clin Med. 2021;10(9).

  58. Xu YX, Wang YB, Tan YL, Xi C, Xu XZ. Prognostic value of pretreatment albumin to bilirubin ratio in patients with hepatocellular cancer: A meta-analysis. Medicine (Baltimore). 2019;98(2):e14027.

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Andreatos N, Amini N, Gani F, Margonis GA, Sasaki K, Thompson VM, et al. Albumin-Bilirubin Score: Predicting Short-Term Outcomes Including Bile Leak and Post-hepatectomy Liver Failure Following Hepatic Resection. J Gastrointest Surg. 2017;21(2):238-48.

    PubMed  Google Scholar 

  60. Wang YY, Zhong JH, Su ZY, Huang JF, Lu SD, Xiang BD, et al. Albumin-bilirubin versus Child-Pugh score as a predictor of outcome after liver resection for hepatocellular carcinoma. Br J Surg. 2016;103(6):725-34.

    CAS  PubMed  Google Scholar 

  61. Okochi O, Kaneko T, Sugimoto H, Inoue S, Takeda S, Nakao A. ICG pulse spectrophotometry for perioperative liver function in hepatectomy. J Surg Res. 2002;103(1):109-13.

    PubMed  Google Scholar 

  62. Le Roy B, Grégoire E, Cossé C, Serji B, Golse N, Adam R, et al. Indocyanine Green Retention Rates at 15 min Predicted Hepatic Decompensation in a Western Population. World J Surg. 2018;42(8):2570-8.

    PubMed  Google Scholar 

  63. Imamura H, Sano K, Sugawara Y, Kokudo N, Makuuchi M. Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test. J Hepatobiliary Pancreat Surg. 2005;12(1):16-22.

    PubMed  Google Scholar 

  64. Fan ST, Lai EC, Lo CM, Ng IO, Wong J. Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis. Arch Surg. 1995;130(2):198-203.

    CAS  PubMed  Google Scholar 

  65. Rassam F, Olthof PB, Bennink RJ, van Gulik TM. Current Modalities for the Assessment of Future Remnant Liver Function. Visc Med. 2017;33(6):442-8.

    PubMed  PubMed Central  Google Scholar 

  66. Ishizawa T, Masuda K, Urano Y, Kawaguchi Y, Satou S, Kaneko J, et al. Mechanistic background and clinical applications of indocyanine green fluorescence imaging of hepatocellular carcinoma. Ann Surg Oncol. 2014;21(2):440-8.

    PubMed  Google Scholar 

  67. Stockmann M, Lock JF, Riecke B, Heyne K, Martus P, Fricke M, et al. Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg. 2009;250(1):119-25.

    PubMed  Google Scholar 

  68. Stockmann M, Lock JF, Malinowski M, Niehues SM, Seehofer D, Neuhaus P. The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB (Oxford). 2010;12(2):139-46.

    PubMed  PubMed Central  Google Scholar 

  69. Blüthner E, Jara M, Shrestha R, Faber W, Pratschke J, Stockmann M, et al. The predictive value of future liver remnant function after liver resection for HCC in noncirrhotic and cirrhotic patients. HPB (Oxford). 2019;21(7):912-22.

    PubMed  Google Scholar 

  70. Anger F, Klein I, Löb S, Wiegering A, Singh G, Sperl D, et al. Preoperative Liver Function Guiding HCC Resection in Normal and Cirrhotic Liver. Visc Med. 2021;37(2):94-101.

    PubMed  Google Scholar 

  71. Rahimli M, Perrakis A, Gumbs AA, Andric M, Al-Madhi S, Arend J, et al. The LiMAx test as selection criteria in minimally invasive liver surgery. J Clin Med. 2022;11(11):3018-22.

  72. Wagener G. Assessment of hepatic function, operative candidacy, and medical management after liver resection in the patient with underlying liver disease. Semin Liver Dis. 2013;33(3):204-12.

    PubMed  Google Scholar 

  73. Ravaioli M, Grazi GL, Principe A, Ercolani G, Cescon M, Gardini A, et al. Operative risk by the lidocaine test (MEGX). in resected patients for HCC on cirrhosis. Hepatogastroenterology. 2003;50(53):1552-5.

    PubMed  Google Scholar 

  74. Lorf T, Schnitzbauer AA, Schaefers SK, Scherer MN, Schlitt HJ, Oellerich M, et al. Prognostic value of the monoethylglycinexylidide (MEGX)-test prior to liver resection. Hepatogastroenterology. 2008;55(82-83):539-43.

    CAS  PubMed  Google Scholar 

  75. Mizuguchi T, Kawamoto M, Meguro M, Hui TT, Hirata K. Preoperative liver function assessments to estimate the prognosis and safety of liver resections. Surg Today. 2014;44(1):1-10.

    PubMed  Google Scholar 

  76. Mizutani Y, Hirai T, Nagamachi S, Nanashima A, Yano K, Kondo K, et al. Prediction of Posthepatectomy Liver Failure Proposed by the International Study Group of Liver Surgery: Residual Liver Function Estimation With 99mTc-Galactosyl Human Serum Albumin Scintigraphy. Clin Nucl Med. 2018;43(2):77-81.

    PubMed  Google Scholar 

  77. Yoshida M, Shiraishi S, Sakamoto F, Beppu T, Utsunomiya D, Okabe H, et al. Assessment of hepatic functional regeneration after hepatectomy using (99m)Tc-GSA SPECT/CT fused imaging. Ann Nucl Med. 2014;28(8):780-8.

    CAS  PubMed  Google Scholar 

  78. Du S, Mao Y, Tong J, Li F, Che L, Li S, et al. A novel liver function evaluation system using radiopharmacokinetic modeling of technetium-99m-DTPA-galactosyl human serum albumin. Nucl Med Commun. 2013;34(9):893-9.

    CAS  PubMed  Google Scholar 

  79. Tanoue Y, Nanashima A, Yano K, Fujii Y, Hiyoshi M, Imamura N, et al. Significance of the preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin in the future remnant liver: a sequential study of regional maximal removal rate of technetium-99m-galactosyl human serum albumin in the whole liver. Nucl Med Commun. 2019;40(2):145-52.

    PubMed  Google Scholar 

  80. Kwon AH, Matsui Y, Kaibori M, Ha-Kawa SK. Preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin (GSA-Rmax). is useful for judging the safety of hepatic resection. Surgery. 2006;140(3):379-86.

    PubMed  Google Scholar 

  81. Mao Y, Du S, Ba J, Li F, Yang H, Lu X, et al. Using Dynamic 99mT c-GSA SPECT/CT fusion images for hepatectomy planning and postoperative liver failure prediction. Ann Surg Oncol. 2015;22(4):1301-7.

    PubMed  Google Scholar 

  82. de Graaf W, Häusler S, Heger M, van Ginhoven TM, van Cappellen G, Bennink RJ, et al. Transporters involved in the hepatic uptake of (99m)Tc-mebrofenin and indocyanine green. J Hepatol. 2011;54(4):738-45.

    PubMed  Google Scholar 

  83. de Graaf W, van Lienden KP, van Gulik TM, Bennink RJ. (99m)Tc-mebrofenin hepatobiliary scintigraphy with SPECT for the assessment of hepatic function and liver functional volume before partial hepatectomy. J Nucl Med. 2010;51(2):229-36.

    PubMed  Google Scholar 

  84. Tomassini F, D'Asseler Y, Linecker M, Giglio MC, Castro-Benitez C, Truant S, et al. Hepatobiliary scintigraphy and kinetic growth rate predict liver failure after ALPPS: a multi-institutional study. HPB (Oxford). 2020;22(10):1420-8.

    PubMed  Google Scholar 

  85. Serenari M, Collaud C, Alvarez FA, de Santibañes M, Giunta D, Pekolj J, et al. Interstage Assessment of Remnant Liver Function in ALPPS Using Hepatobiliary Scintigraphy: Prediction of Posthepatectomy Liver Failure and Introduction of the HIBA Index. Ann Surg. 2018;267(6):1141-7.

    PubMed  Google Scholar 

  86. Truant S, Baillet C, Deshorgue AC, Leteurtre E, Hebbar M, Ernst O, et al. Drop of Total Liver Function in the Interstages of the New Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Technique: Analysis of the "Auxiliary Liver" by HIDA Scintigraphy. Ann Surg. 2016;263(3):e33-4.

    PubMed  Google Scholar 

  87. Haimerl M, Fuhrmann I, Poelsterl S, Fellner C, Nickel MD, Weigand K, et al. Gd-EOB-DTPA-enhanced T1 relaxometry for assessment of liver function determined by real-time 13C-methacetin breath test. European Radiology. 2018;28(9):3591-600.

    PubMed  Google Scholar 

  88. Araki K, Harimoto N, Kubo N, Watanabe A, Igarashi T, Tsukagoshi M, et al. Functional remnant liver volumetry using Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI). predicts post-hepatectomy liver failure in resection of more than one segment. HPB (Oxford). 2020;22(2):318-27.

    PubMed  Google Scholar 

  89. Wiggans MG, Lordan JT, Shahtahmassebi G, Aroori S, Bowles MJ, Stell DA. The Interaction between Diabetes, Body Mass Index, Hepatic Steatosis, and Risk of Liver Resection: Insulin Dependent Diabetes Is the Greatest Risk for Major Complications. HPB Surg. 2014;2014:586159.

    CAS  PubMed  PubMed Central  Google Scholar 

  90. Yamamoto Y. Evaluation of Liver Function and the Role of Biliary Drainage before Major Hepatic Resections. Visc Med. 2021;37(1):10-7.

    PubMed  Google Scholar 

  91. Abbasi A, Rahnemai-Azar AA, Merath K, Weber SM, Abbott DE, Dillhoff M, et al. Role of associating liver partition and portal vein ligation in staged hepatectomy (ALPPS)-strategy for colorectal liver metastases. Transl Gastroenterol Hepatol. 2018;3:66.

    PubMed  PubMed Central  Google Scholar 

  92. Ribero D, Abdalla EK, Madoff DC, Donadon M, Loyer EM, Vauthey JN. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg. 2007;94(11):1386-94.

    CAS  PubMed  Google Scholar 

  93. Makuuchi M, Thai BL, Takayasu K, Takayama T, Kosuge T, Gunvén P, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990;107(5):521-7.

    CAS  PubMed  Google Scholar 

  94. Abdalla EK, Hicks ME, Vauthey JN. Portal vein embolization: rationale, technique and future prospects. Br J Surg. 2001;88(2):165-75.

    CAS  PubMed  Google Scholar 

  95. Capussotti L, Muratore A, Baracchi F, Lelong B, Ferrero A, Regge D, et al. Portal vein ligation as an efficient method of increasing the future liver remnant volume in the surgical treatment of colorectal metastases. Arch Surg. 2008;143(10):978-82; discussion 82.

    PubMed  Google Scholar 

  96. Schnitzbauer AA, Lang SA, Goessmann H, Nadalin S, Baumgart J, Farkas SA, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012;255(3):405-14.

    PubMed  Google Scholar 

  97. Schadde E, Schnitzbauer AA, Tschuor C, Raptis DA, Bechstein WO, Clavien PA. Systematic review and meta-analysis of feasibility, safety, and efficacy of a novel procedure: associating liver partition and portal vein ligation for staged hepatectomy. Ann Surg Oncol. 2015;22(9):3109-20.

    PubMed  Google Scholar 

  98. Kandiah PA, Olson JC, Subramanian RM. Emerging strategies for the treatment of patients with acute hepatic failure. Curr Opin Crit Care. 2016;22(2):142-51.

    PubMed  Google Scholar 

  99. Polson J, Lee WM, Disease AAftSoL. AASLD position paper: the management of acute liver failure. Hepatology. 2005;41(5):1179-97.

    PubMed  Google Scholar 

  100. Golse N, Bucur PO, Adam R, Castaing D, Sa Cunha A, Vibert E. New Paradigms in Post-hepatectomy Liver Failure. Journal of Gastrointestinal Surgery. 2013;17(3):593-605.

    PubMed  Google Scholar 

  101. van de Kerkhove MP, de Jong KP, Rijken AM, de Pont AC, van Gulik TM. MARS treatment in posthepatectomy liver failure. Liver Int. 2003;23 Suppl 3:44-51.

    PubMed  Google Scholar 

  102. Demetriou AA, Brown RS, Busuttil RW, Fair J, McGuire BM, Rosenthal P, et al. Prospective, randomized, multicenter, controlled trial of a bioartificial liver in treating acute liver failure. Ann Surg. 2004;239(5):660-7; discussion 7-70.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, University of Texas Health Science Center San Antonio MD Anderson Cancer Center, San Antonio, TX, USA

    Katiuscha Merath MD, Ankur Tiwari MD, Colin Court MD PhD & Alexander Parikh MD MPH

  2. Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670, Columbus, OH, USA

    Mary Dillhoff MD, Jordan Cloyd MD, Aslam Ejaz MD & Timothy M. Pawlik MD PhD MPH MTS MBA

Authors
  1. Katiuscha Merath MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ankur Tiwari MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Colin Court MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander Parikh MD MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mary Dillhoff MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jordan Cloyd MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aslam Ejaz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Timothy M. Pawlik MD PhD MPH MTS MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy M. Pawlik MD PhD MPH MTS MBA.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Merath, K., Tiwari, A., Court, C. et al. Postoperative Liver Failure: Definitions, Risk factors, Prediction Models and Prevention Strategies. J Gastrointest Surg 27, 2640–2649 (2023). https://doi.org/10.1007/s11605-023-05834-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-023-05834-2

Keywords

Search

Navigation