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Post-hepatectomy liver failure
Post-hepatectomy liver failure (PHLF) is a clinically important deterioration in liver function after hepatic resection. The ISGLS definition combines increased INR and hyperbilirubinaemia on or after postoperative day 5, with severity graded according to the change in clinical management. Prevention depends on patient selection, assessment of the future liver remnant and meticulous perioperative care. Once established, management is mainly supportive: identify vascular, biliary and septic complications, preserve perfusion, support failing organs and involve an experienced HPB and transplant centre early in severe or progressive cases.
Key information
Guidelines and position statements
Relevant clinical practice guidelines, practice guidance, consensus statements and position papers from professional bodies and expert groups.
Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery
ISGLS · consensus definition · Surgery · 2011
The standard definition and A–C grading system used in clinical reporting and research.
Open resource →Further context
Other useful resources
Selected review articles, practical explainers, expert discussions, reference sites and e-learning from established providers.
Current evidence on posthepatectomy liver failure: comprehensive review
Søreide JA, Deshpande R. BJS Open. 2022;6(6):zrac142.
A broad contemporary review of definitions, prediction, prevention and treatment, including the limited role of transplantation.
Open resource →Preoperative assessment of liver function and perioperative management of posthepatectomy liver failure
World Journal of Gastroenterology · review · 2024
A practical review of future liver remnant assessment, prevention and perioperative management.
Open resource →Role of liver support systems in the management of post hepatectomy liver failure
Pufal K, et al. Ann Hepatobiliary Pancreat Surg. 2021;25(2):171–178.
A systematic review showing that evidence for plasma exchange and albumin dialysis remains insufficient for routine use.
Open resource →Postoperative management after hepatic resection
Journal of Gastrointestinal Oncology · practical review
A practical account of early postoperative physiology, complications and supportive management after liver resection.
Open resource →