International Study Group of Liver Surgery (ISGLS) Severity Grades of Posthepatectomy Liver Failure (PHLF)

 

In hepatic failure the liver is not capable of providing synthetic, excretory and detoxifying functions.

 

Patient selection: status post hepatic resection

 

Criteria for posthepatectomy liver failure (PHLF):

(1) Prolongation of the INR and increases in total serum bilirubin on postoperative day 5 compared to postoperative day 4.

(2) The change cannot be explained by biliary obstruction or other obvious cause.

 

where:

• Evaluation of INR and total serum bilirubin on day 5 is similar to the 50-50 criteria of Balzan et al.

 

Parameters for a patient with evidence of PHLF:

(1) adherence to standard management protocol

(2) invasive procedure required

 

Adherence to Standard Protocol	Invasive Procedure Required	Grade
no change	NA	A
change	no	B
change	yes	C