Background The present study aimed to observe the dynamic changes in liver function from the pre- to post-operative period, and explore the feasibility of using pre-operative information, including two-dimensional shear wave elastography (2D-SWE) measured liver stiffness (LS), to predict the long-term post-operative liver function in patients with hepatocellular carcinoma (HCC) and chronic hepatitis B (CHB).

Methods 250 patients with treatment-naive HCC, as well as CHB and undergoing hepatectomy, were consecutively enrolled. Before reaching the endpoint (recurrence, death, or initiation of subsequent treatment), patients were followed up for one year. Liver function indexes were collected at postoperative day 5, 1 month, 3 months, 6 months, and 12 months, respectively. Analysis of variance analysis and Tukey’s multiple comparisons were conducted to explore the changes in liver function. A model was built for liver function by pre-operative indexes according to multivariate linear regression analysis.

Results Analysis revealed that the albumin-bilirubin (ALBI) score exhibited a trend of initially rising and then declining from pre- to post-operative (p <0.001), and it was stabilized after 1 month from the hepatectomy (p >0.050). Moreover, the ALBI score after 1-month post-operation was lower than the pre-operative (p <0.050). Multivariate analysis revealed that the age (p =0.019), pre-operative albumin (ALB, p <0.001), carcinoembryonic antigen (CEA, p <0.001), and LS (p =0.008) were independently associated with the difference between the pre-operative and 1-month post-operative ALBI scores. Accordingly, a predictive model was built. Comparing the post-operative ALBI predicted by the model with the actual post-operative ALBI grade of the patients, the prediction of poor post-operative liver function (ALBI grade ≥2) had good sensitivity (>0.70 at each time point).

Conclusions The patient‘s liver function tended to stabilize at approximately 1 month after hepatectomy. Age and pre-operative TBIL, ALB, CEA, and 2D-SWE measurements appeared to have a certain degree of predictive value for liver function in HCC patients with concomitant CHB, and a model was built to assist in the prediction of liver function in surgical patients.