Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS)

What this platform has drawn from it — 9 claims

• The International Study Group of Liver Surgery defines post-hepatectomy liver failure as a postoperatively acquired deterioration in the liver's ability to maintain its synthetic, excretory and detoxifying functions, characterised by an increased INR together with concomitant hyperbilirubinaemia on or after postoperative day 5. Results, 'Consensus definition of posthepatectomy liver failure', p. 715
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• The ISGLS definition sets no general numeric thresholds: increased INR and hyperbilirubinaemia are defined against the normal cut-off levels of the local laboratory, and other obvious causes of the biochemical and clinical changes, such as biliary obstruction, must be excluded. Results, 'Consensus definition of posthepatectomy liver failure', p. 715, sentence following the definition · Table II, Definition row, p. 719
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• Where INR or serum bilirubin is already raised before operation, ISGLS post-hepatectomy liver failure is defined instead by an increasing INR and increasing serum bilirubin on or after postoperative day 5, compared with the previous day's values. Table II, Definition row, p. 719
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• The ISGLS definition also treats the need for clotting factors such as fresh frozen plasma to maintain a normal INR on or after postoperative day 5, in combination with hyperbilirubinaemia, as post-hepatectomy liver failure. Results, 'Consensus definition of posthepatectomy liver failure', p. 715
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• ISGLS grades post-hepatectomy liver failure by the worst criterion identified: fulfilling at least one criterion of non-invasive or invasive intervention classifies a patient as grade B or grade C respectively. Results, 'Grading of severity of posthepatectomy liver failure', p. 715
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• ISGLS grade A post-hepatectomy liver failure is a postoperative deterioration of liver function that does not require a change in the patient's clinical management. Results, 'Grading of severity of posthepatectomy liver failure', grade A
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• ISGLS grade B post-hepatectomy liver failure is diagnosed where there is a deviation from the regular postoperative clinical pathway that can be managed without invasive treatment; non-invasive treatment may include fresh frozen plasma, albumin, daily diuretics and non-invasive ventilation. Results, 'Grading of severity of posthepatectomy liver failure', grade B
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• ISGLS grade C post-hepatectomy liver failure is diagnosed where an invasive procedure is required; the invasive procedures named are haemodialysis, intubation and mechanical ventilation, extracorporeal liver support, rescue hepatectomy and transplantation. Results, 'Grading of severity of posthepatectomy liver failure', grade C
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• The ISGLS states that a uniform definition of post-hepatectomy liver failure was needed to enable valid comparison of results between studies across institutions and countries. Introduction, p. 714
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