Introduction Liver failure is a potentially fatal complication following major hepatic resection. This study evaluates the incidence and factors associated with posthepatectomy liver failure (PHLF), as well as the outcomes and survival of these patients.
Methods All patients who underwent elective major hepatic resection (>4 liver segments) between January 2001 and March 2011 were identified from a prospective database. Patients with bilirubin levels >100 mmol/l or INR >2 on three consecutive days within the first post-operative week were diagnosed with PHLF (n=54). These patients were compared with 654 control patients.
Results Patients with PHLF had a higher incidence of diabetes mellitus compared to the control group (9.5% vs 3.1%, p=0.05). There was no significant difference in age, pre-operative chemotherapy, weight of resected specimen, use of Pringle manoeuvre, degree of steatosis/fibrosis of background liver, or amount of perioperative blood transfusion. Post-operatively, patients with PHLF were more likely to require n-acetylcysteine (51.4% vs 13.4%, p<0.001) and dialysis (13.2% vs 1.8%, p<0.001), and had longer ITU stay (mean 2.57 days vs 0.84 days, p<0.001). The PHLF group had higher 30-day (22.6% vs 3.1%, p<0.001) and 90-day mortality (41.5% vs 4.7%, p<0.001). Median survival was 9.86 months in the PHLF group and 49.77 months in the control group (p<0.001).
Conclusion This study over a 10-year period has shown a small risk of PHLF (7.6%) in patients undergoing major hepatic resection. PHLF is associated with significantly increased post-operative morbidity and mortality.
Competing interests None declared.