Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS)
Abstract
Background Posthepatectomy liver failure is a feared complication after hepatic resection and a major cause of perioperative mortality. There is currently no standardized definition of posthepatectomy liver failure that allows valid comparison of results from different studies and institutions. The aim of the current article was to propose a definition and grading of severity of posthepatectomy liver failure. Methods A literature search on posthepatectomy liver failure after hepatic resection was conducted. Based on the normal course of biochemical liver function tests after hepatic resection, a simple and easily applicable definition of posthepatectomy liver failure was developed by the International Study Group of Liver Surgery. Furthermore, a grading of severity is proposed based on the impact on patients' clinical management. Results No uniform definition of posthepatectomy liver failure has been established in the literature addressing hepatic surgery. Considering the normal postoperative course of serum bilirubin concentration and International Normalized Ratio, we propose defining posthepatectomy liver failure as the impaired ability of the liver to maintain its synthetic, excretory, and detoxifying functions, which are characterized by an increased international normalized ratio and concomitant hyperbilirubinemia (according to the normal limits of the local laboratory) on or after postoperative day 5. The severity of posthepatectomy liver failure should be graded base…
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Among several definitions for PHLF, the International Study Group of Liver Surgery criteria are most accepted, based on bilirubin and prothrombin time outside normal ranges on postoperative day 5 or later.
“Amongst several definitions for PHLF the International Study Group of Liver Surgery (ISGLS) criteria are most accepted (see Refs. [6,9,10]) based on bilirubin and prothrombin time outside normal ranges on postoperative day 5 or later.”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [6]
Post-hepatectomy liver failure remains a challenging complication in patients undergoing liver resection and represents the major cause of mortality.
“Post-hepatectomy liver failure (PHLF) remains a challenging complication in patients undergoing liver resection and represents the major cause of mortality [5,6,7].”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [6]
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“Future prospective, multicenter studies should adopt not only pre-defined primary endpoints and PHLF definitions (ideally as proposed by the ISGLS [6]), but also harmonized IL-6 measurement schedules and uniform assay platforms across different centers to facilitate valid pooled analyses.”
Primavesi, F., Senoner, T., Schindler, S., Nikolajevic, A., Di Fazio, P., Csukovich, G., Eller, S., Neumayer, B., Anliker, M., Braunwarth, E., et al. (2024) · Antioxidants · doi:10.3390/antiox13050590 · Cited by 3 · see citing works
- Authors
- Rahbari, N. N., Garden, O. J., Padbury, R., Brooke-Smith, M., Crawford, M., Adam, R., Koch, M., Makuuchi, M., Dematteo, R. P., Christophi, C., Banting, S., Usatoff, V., Nagino, M., Maddern, G., Hugh, T. J., Vauthey, J.-N., Greig, P., Rees, M., Yokoyama, Y., Fan, S. T., Nimura, Y., Figueras, J., Capussotti, L., Büchler, M. W., & Weitz, J.
- Affiliations
- Heidelberg University (DE)
- University of Edinburgh (GB)
- Flinders Medical Centre (AU)
- Royal Prince Alfred Hospital (AU)
- The University of Tokyo (JP)
- Memorial Sloan Kettering Cancer Center (US)
- The University of Melbourne (AU)
- St Vincent's Hospital Melbourne (AU)
- The Alfred Hospital (AU)
- Nagoya University (JP)
- Queen Elizabeth Hospital (AU)
- Royal North Shore Hospital (AU)
- The University of Texas MD Anderson Cancer Center (US)
- University of Toronto (CA)
- Basingstoke and North Hampshire Hospital (GB)
- Queen Mary Hospital (CN)
- Universitat de Girona (ES)
- Candiolo Cancer Institute (IT)
- Corresponding author
- Büchler, Markus W.
- ORCID
- Venue
- Surgery
- Publisher
- Elsevier BV
- Published
- 2011-05
- Volume
- 149
- Issue
- 5
- Pages
- 713-724
- ISSN
- 0039-6060 (ISSN-L)
- OpenAlex
- W2137869551
- Cited by
- 2,319
- References
- 0
- Citations by year
- 2026: 176 · 2025: 186 · 2024: 247 · 2023: 215 · 2022: 225 · 2021: 224 · 2020: 190 · 2019: 152 · 2018: 142 · 2017: 140 · 2016: 133 · 2015: 113 · 2014: 71 · 2013: 66 · 2012: 24
- FWCI
- 34.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Surgery (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Site cant be reached (submittedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- post-hepatectomy liver failure, hepatectomy, severity classification, international normalized ratio, hyperbilirubinemia, serum bilirubin, liver synthetic function, perioperative mortality
- MeSH terms
- Bilirubin, Hepatectomy, Humans, International Cooperation, Liver, Liver Function Tests, Postoperative Complications, Severity of Illness Index, Liver Failure
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