Post-hepatectomy liver failure
Post-hepatectomy liver failure
Post-hepatectomy liver failure is a postoperatively acquired deterioration in the ability of the liver to maintain its synthetic, excretory and detoxifying functions, characterised by an increased INR together with concomitant hyperbilirubinaemia on or after postoperative day 5.
International Study Group of Liver Surgery — Results, 'Consensus definition of posthepatectomy liver failure', p. 715
The exact wording of the source
Results, 'Consensus definition of posthepatectomy liver failure', p. 715 · status: current, verified 2026-09-01
Open
Based on these data, we have defined PHLF as a postoperatively acquired deterioration in the ability of the liver to maintain its synthetic, excretory, and detoxifying functions, which are characterized by an increased INR and concomitant hyperbilirubinemia on or after postoperative day 5.
The 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.
International Study Group of Liver Surgery — Results, 'Consensus definition of posthepatectomy liver failure', p. 715, sentence following the definition · International Study Group of Liver Surgery — Table II, Definition row, p. 719
The exact wording of the source
Results, 'Consensus definition of posthepatectomy liver failure', p. 715, sentence following the definition · status: current, verified 2026-09-01
Open
Increased INR and hyperbilirubinemia are defined according to the normal range of cut-off levels of the local laboratory.
Table II, Definition row, p. 719 · status: current, verified 2026-09-01
Open
Other obvious causes for the observed biochemical and clinical alterations such as biliary obstruction should be ruled out.
Where INR or serum bilirubin is already raised before the operation, the diagnosis is made instead by an increasing INR and an increasing serum bilirubin on or after postoperative day 5, compared with the previous day's values.
International Study Group of Liver Surgery — Table II, Definition row, p. 719
The exact wording of the source
Table II, Definition row, p. 719 · status: current, verified 2026-09-01
Open
If INR or serum bilirubin concentration is increased preoperatively, PHLF is defined by an increasing INR (decreasing prothrombin time) and increasing serum bilirubin concentration on or after postoperative day 5 (compared with the values of the previous day).
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, is also considered post-hepatectomy liver failure.
International Study Group of Liver Surgery — Results, 'Consensus definition of posthepatectomy liver failure', p. 715
The exact wording of the source
Results, 'Consensus definition of posthepatectomy liver failure', p. 715 · status: current, verified 2026-09-01
Open
Furthermore, the need for clotting factors such as fresh frozen plasma (FFP) to maintain normal INR on or after postoperative day 5 in combination with hyperbilirubinemia is considered PHLF.
Severity is graded 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.
International Study Group of Liver Surgery — Results, 'Grading of severity of posthepatectomy liver failure', p. 715
The exact wording of the source
Results, 'Grading of severity of posthepatectomy liver failure', p. 715 · status: current, verified 2026-09-01
Open
A patient's PHLF is graded by the worst identified criteria (ie, by fulfilling at least 1 criterion of noninvasive or invasive intervention, patients are classified to have PHLF grade B and C, respectively).
Grade A is a postoperative deterioration of liver function that does not require a change in the patient's clinical management.
International Study Group of Liver Surgery — Results, 'Grading of severity of posthepatectomy liver failure', grade A
The exact wording of the source
Results, 'Grading of severity of posthepatectomy liver failure', grade A · status: current, verified 2026-09-01
Open
Grade A PHLF represents a postoperative deterioration of liver function that does not require a change in the patient's clinical management.
Grade B 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.
International Study Group of Liver Surgery — Results, 'Grading of severity of posthepatectomy liver failure', grade B
The exact wording of the source
Results, 'Grading of severity of posthepatectomy liver failure', grade B · status: current, verified 2026-09-01
Open
Patients are diagnosed with grade B PHLF if there is a deviation from the regular, postoperative clinical pathway, but they can be managed without invasive treatment. Noninvasive treatment may include administration of FFP, albumin, daily diuretics, and noninvasive ventilation.
Grade C is post-hepatectomy liver failure requiring an invasive procedure. The procedures named are haemodialysis, intubation and mechanical ventilation, extracorporeal liver support, rescue hepatectomy, and transplantation.
International Study Group of Liver Surgery — Results, 'Grading of severity of posthepatectomy liver failure', grade C
The exact wording of the source
Results, 'Grading of severity of posthepatectomy liver failure', grade C · status: current, verified 2026-09-01
Open
Patients who develop PHLF requiring an invasive procedure are classified as having grade C PHLF. Invasive procedures include hemodialysis, intubation and mechanical ventilation, extracorporeal liver support, rescue hepatectomy, and transplantation.
The group's stated reason for agreeing a uniform definition was to enable valid comparison of results between studies across institutions and countries.
International Study Group of Liver Surgery — Introduction, p. 714
The exact wording of the source
Introduction, p. 714 · status: current, verified 2026-09-01
Open
Because of the increasing relevance of PHLF and its impact on perioperative outcome, a uniform definition of this complication is needed to enable a valid comparison of results between different studies across multiple institutions and countries.
Related
- Extracorporeal liver support — is treated with
- Liver resection — can be caused by
- Liver transplantation — is treated with
- ISGLS PHLF grading — is classified by
- Acute liver failure — related through liver transplantation
- UKELD — related through liver transplantation
What we have not established
Relationships involving Post-hepatectomy liver failure that we have not evidenced are listed, never drawn — a line would read as a weak relationship, which is a different and false claim.
- Post-hepatectomy liver failure → ISGLS PHLF grading — not established
- Liver resection → Post-hepatectomy liver failure — not established
- Liver regeneration → Post-hepatectomy liver failure — not established
Evidence search date: 2026-09-01
Content reviewed and approved
What we have not established here
Known gaps on this concept:
THE 'EXTRACORPOREAL LIVER SUPPORT' PHRASE IN GRADE C IS NOT RESOLVED. Phase 17 acquired the UK and European positions on liver support devices and found they all concern acute or acute-on-chronic liver failure - three different populations from post-hepatectomy liver failure - and that nothing establishes what ISGLS meant by the phrase. The pointer is left open and labelled rather than closed by inference.
NO RESECTION ELIGIBILITY. This page does not say who can have liver surgery, and that is deliberate. The acquired corpus states the functional-remnant principle and cannot state the practice: every source says 'adequate remnant' and none gives a volume threshold, portal vein embolisation is absent entirely, and functional assessment beyond Child-Pugh is unheld. A page repeating 'adequate remnant' three times would look authoritative and tell a reader nothing.
THE BSG AND EASL RESECTION RECOMMENDATIONS ARE VERIFIED AND NOT PUBLISHED. The BSG line that resection is first-line for solitary HCC 'of any size' when liver function is maintained must never appear without the EASL recommendation that clinically significant portal hypertension with Child-Pugh B is an absolute contraindication to resection of more than two segments, and without the paired EASL recommendation that the same combination is NOT an absolute contraindication to limited minimally invasive resection. Publishing any one of those three alone states a different rule than the guidelines do.
The ISGLS enumerated criteria tables are not held. The definition, the cut-off rule, the exclusion and the three grades are; the full criterion lists behind grades B and C are not, and grade assignment therefore cannot be performed from this page.
No plain-language account of what post-hepatectomy liver failure feels like or how it is treated. The plain layer here covers only liver regrowth and what it depends on.
A University Hospitals Plymouth leaflet stated directly that where the liver is severely damaged by cirrhosis it may not be safe to have surgery. Its URL now returns HTTP 404, so it could not be re-verified and nothing rests on it.
No research resolution.
What has changed here
2026-09-01 — Concept created at plain, clinical and specialist resolutions - the platform's first concept to offer specialist depth.
Phase 16. Post-hepatectomy liver failure is this platform's own subject arriving through the operating theatre: liver failure caused by treatment, in a patient selected as fit for it. The ISGLS definition was cited in the ledger and unread since Phase 1; reading it required eight access routes, seven of which failed.