• Lucia Calthorpe, Nikdokht Rashidian, CacciaguerraAndrea BenedettiABDepartment of Surgery, Poliambulanza Foundation Hospital, Brescia, italy.Department of Surgery, University Hospital Southampton NHS Trust, Southampton, UK., Patricia C Conroy, Taizo Hibi, HilalMohammad AbuMADepartment of Surgery, Poliambulanza Foundation Hospital, Brescia, italy.Department of Surgery, University Hospital Southampton NHS Trust, Southampton, UK., Daniel Hoffman, Keon Min Park, Jaeyun Wang, Mohamed Abdelgadir Adam, Adnan Alseidi, and International Post-Hepatectomy Liver Failure Study Group.
• School of Medicine, University of California San Francisco, San Francisco, CA.
• Ann. Surg. 2023 Mar 1; 277 (3): e592e596e592-e596.

ObjectiveTo compare different criteria for post-hepatectomy liver failure (PHLF) and evaluate the association between International Study Group of Liver Surgery (ISGLS) PHLF and the Comprehensive Complication Index (CCI)" and 90-day mortality.Summary Of Background DataPHLF is a serious complication following hepatic resection. Multiple criteria have been developed to characterize PHLF.MethodsAdults who underwent major hepatectomies at twelve international centers (2010-2020) were included. We identified patients who met criteria for PHLF based on three definitions: 1) ISGLS, 2) Balzan (INR > 1.7 and bilirubin > 2.92mg/dL) or 3) Mullen (peak bilirubin >7mg/dL). We compared the 90-day mortality and major morbidity predicted by each definition. We then used logistic regression to determine the odds of CCI>40 and 90-day mortality associated with ISGLS grades.ResultsAmong 1646 included patients, 19 (1.1%) met Balzan, 68 (4.1%) met Mullen, and 444 (27.0%) met ISGLS criteria for PHLF. Of the three definitions, the ISGLS criteria best predicted 90-day mortality (AUC = 0.72; sensitivity 69.4%). Patients with ISGLS grades B&C were at increased odds of CCI > 40 (grade B OR 4.0; 95% CI: 2.2-7.2; grade C OR 137.0; 95% CI: 59.2-317.4). Patients with ISGLS grade C were at increased odds of 90-day mortality (OR 113.6; 95% CI: 55.6-232.1). Grade A was not associated with CCI> 40 or 90-day mortality.ConclusionsIn this diverse international cohort of major hepatectomies, ISGLS grade A was not associated with 90-day mortality or high CCI, calling into question the current classification of patients in this group as having clinically significant PHLF.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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