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Cited by 88Organ Transplantation Techniques and OutcomesHepatocellular Carcinoma Treatment and PrognosisLiver physiology and pathology

Current evidence on posthepatectomy liver failure: Comprehensive review

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Sparrelid, Ernesto, Olthof, Pim B, Dasari, Bobby V M, Erdmann, Joris I, Santol, Jonas, Starlinger, Patrick, Gilg, Stefan·2022·BJS Open
DOI 10.1093/bjsopen/zrac142PMC PMC9681670
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Abstract

Introduction: Despite important advances in many areas of hepatobiliary surgical practice during the past decades, posthepatectomy liver failure (PHLF) still represents an important clinical challenge for the hepatobiliary surgeon. The aim of this review is to present the current body of evidence regarding different aspects of PHLF. Methods: A literature review was conducted to identify relevant articles for each topic of PHLF covered in this review. The literature search was performed using Medical Subject Heading terms on PubMed for articles on PHLF in English until May 2022. Results: Uniform reporting on PHLF is lacking due to the use of various definitions in the literature. There is no consensus on optimal preoperative assessment before major hepatectomy to avoid PHLF, although many try to estimate future liver remnant function. Once PHLF occurs, there is still no effective treatment, except liver transplantation, where the reported experience is limited. Discussion: Strict adherence to one definition is advised when reporting data on PHLF. The use of the International Study Group of Liver Surgery criteria of PHLF is recommended. There is still no widespread established method for future liver remnant function assessment. Liver transplantation is currently the only effective way to treat severe, intractable PHLF, but for many indications, this treatment is not available in most countries.

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  • Consequently, IL-6 is produced in high amounts in Kupffer cells with increased release into surrounding tissues, and hepatocytes respond by initiating growth and promoting liver regeneration.

    “Consequently, IL-6 is produced in high amounts in Kupffer cells, with a consecutive increased release into surrounding tissues. Specifically, hepatocytes then respond by initiating growth and promoting liver regeneration.”

    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 [5]

    The Aetiology section states that activated Kupffer cells produce IL-6 and that IL-6 activates hepatocytes to initiate proliferation; Fig. 1 also describes IL-6 release from Kupffer cells as promoting liver regeneration. The cited passages do not establish that IL-6 is produced in high amounts or that its release into surrounding tissues increases. Page numbers were not supplied. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • In the regenerative context, a significant increase in TNF-alpha activates transcription factors in Kupffer cells and hepatocytes, including NF-kappaB and STAT3.

    “In this regenerative context (Figure 1B), a significant increase in tumor-necrosis factor alpha (TNF-α) activates various transcription factors in Kupffer cells and hepatocytes, including nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and signal transducer and activator of transcription 3 (STAT3) [5].”

    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 [5]

  • Insufficient postoperative liver regeneration can be caused secondarily by infection, especially abdominal sepsis, in addition to limited future liver remnant volume.

    “Intriguingly, insufficient postoperative liver regeneration not only occurs due to primarily limited volume (small-for-size) of the future liver remnant (FLR), but can also be caused secondarily by infection, especially abdominal sepsis [5,15].”

    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 [5]

  • 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 [5]

  • Most publications are underpowered to assess CR-PHLF with event rates of 5-15%, with commonly less than 50 patients included per study.

    “With commonly less than 50 patients included per study, most publications are underpowered to assess CR-PHLF with event rates of 5–15% according to the literature [5,7,13,38,39].”

    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 [5]

    The Epidemiology passage (page unavailable) reports PHLF incidence of 9–20% in some cohorts and under 5% in another, but does not give a 5–15% rate for clinically relevant PHLF. Searches for statistical power, event rates, and studies with fewer than 50 patients found no passage supporting the claim that most publications are underpowered. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Authors
Sparrelid, E., Olthof, P. B., Dasari, B. V. M., Erdmann, J. I., Santol, J., Starlinger, P., & Gilg, S.
Affiliations
  • Karolinska University Hospital (SE)
  • Erasmus MC (NL)
  • Queen Elizabeth Hospital Birmingham (GB)
  • Amsterdam University Medical Centers (NL)
  • Sigmund Freud Privatuniversität Wien (AT)
  • Mayo Clinic (US)
Corresponding author
Sparrelid, Ernesto
ORCID
Venue
BJS Open
Publisher
Oxford University Press (OUP)
Published
2022-11-02
Volume
6
Issue
6
ISSN
2474-9842 (ISSN-L)
DOI
10.1093/bjsopen/zrac142
PMC
PMC9681670
OpenAlex
W4309682149
Cited by
88
References
3
Citations by year
2026: 18 · 2025: 26 · 2024: 31 · 2023: 13
FWCI
4.16
Type
journal article
Language
en
Open access
Licence
Locations
  • BJS Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • Pure Amsterdam UMC (submittedVersion, other-oa)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by-nc)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
  • Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
  • Health Sciences › Medicine › Hepatology › Liver physiology and pathology
Keywords
post-hepatectomy liver failure, hepatectomy, liver transplantation, preoperative assessment, hepatobiliary surgery
MeSH terms
Hepatectomy, Humans, Liver Function Tests, Risk Factors, Liver Failure

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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