The Analysis of Posthepatectomy Liver Failure Incidence and Risk Factors Among Right Liver Living Donors According to International Study Group of Liver Surgery Definition

Egeli, Tufan; Ünek, Tarkan; Ağalar, Cihan; Özbilgin, Mücahit; Derici, Serhan; Cevlik, A.D.; Akarsu, Mesut; Altay, Canan; Obuz, Funda; Ellıdokuz, Hülya; Astarcıoğlu, İbrahim

doi:10.1016/j.transproceed.2019.01.088

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…Although some studies already exclude grade A in their analyses, others consider all grades together as PHLF. 23,24 Furthermore, the range of postoperative morbidity experienced among those with grade B PHLF suggests that this category may be amenable to further substratification. Ultimately, formalizing the distinction between grades could address inconsistent operationalization of PHLF in future studies and optimize our ability to develop models that accurately predict clinically meaningful liver failure.…”

Section: Discussionmentioning

confidence: 99%

Using the Comprehensive Complication Index to Rethink the ISGLS Criteria for Post-hepatectomy Liver Failure in an International Cohort of Major Hepatectomies

et al. 2021

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Objective: To compare different criteria for post-hepatectomy liver failure (PHLF) and evaluate the association between International Study Group of Liver Surgery (ISGLS) PHLF and the Comprehensive Complication Index (CCI) and 90-day mortality.Summary Background Data: PHLF is a serious complication following hepatic resection. Multiple criteria have been developed to characterize PHLF.Methods: Adults who underwent major hepatectomies at twelve international centers (2010-2020) were included. We identified patients who met criteria for PHLF based on three definitions: 1) ISGLS, 2) Balzan (INR >1.7 and bilirubin >2.92 mg/dL) or 3) Mullen (peak bilirubin >7 mg/dL). We compared the 90-day mortality and major morbidity predicted by each definition. We then used logistic regression to determine the odds of CCI>40 and 90day mortality associated with ISGLS grades.Results: Among 1646 included patients, 19 (1.1%) met Balzan, 68 (4.1%) met Mullen, and 444 (27.0%) met ISGLS criteria for PHLF. Of the three definitions, the ISGLS criteria best predicted 90-day mortality (AUC=0.72; sensitivity 69.4%). Patients with ISGLS grades B&C were at increased odds of CCI>40 (grade B OR 4.0; 95% CI: 2.2-7.2; grade C OR 137.0; 95% CI: 59.2-317.4). Patients with ISGLS grade C were at increased odds of 90-day mortality (OR 113.6;. Grade A was not associated with CCI>40 or 90day mortality. Conclusions:In this diverse international cohort of major hepatectomies, ISGLS grade A was not associated with 90-day mortality or high CCI, calling into question the current classification of patients in this group as having clinically significant PHLF.

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Section: Discussionmentioning

confidence: 99%

Using the Comprehensive Complication Index to Rethink the ISGLS Criteria for Post-hepatectomy Liver Failure in an International Cohort of Major Hepatectomies

et al. 2021

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“…Our finding may be clinically relevant: for instance, when the risk of PHLF must be reduced to zero, as in livingdonor hepatectomy [5,36,37], the safest cutoff value of remnant liver function (FLR-F > 2.79%/min/m 2 or HIBAi > 23.8%) should be used. On the contrary, if the risk of dropout between stages, as in PVE or TSH, is deemed to be higher than the risk of grade A PHLF [22], a lower cutoff can be considered (FLR-F ≥ 1.85%/min/m 2 or HIBAi ≥ 16.8%).…”

Section: Discussionmentioning

confidence: 89%

The role of hepatobiliary scintigraphy combined with spect/ct in predicting severity of liver failure before major hepatectomy: a single-center pilot study

et al. 2020

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Hepatobiliary scintigraphy (HBS) has been demonstrated to predict post-hepatectomy liver failure (PHLF). However, existing cutoff values for future liver remnant function (FLR-F) were previously set according to the “50–50 criteria” PHLF definition. Methods of calculation and fields of application in liver surgery have changed in the meantime. The aim of this study was to demonstrate the role of HBS combined with single photon emission computed tomography (SPECT/CT) in predicting severity of PHLF, according to the International Study Group of Liver Surgery (ISGLS). All patients submitted to major hepatectomy with preoperative HBS-SPECT/CT between November 2016 and December 2019, were analyzed. Patients were resected according to hepatic volumetry. Receiver operating characteristic (ROC) curve analysis was performed to identify cutoffs of FLR function for predicting PHLF according to ISGLS definition and grading. Of the 38 patients enrolled, 26 were submitted to one-stage hepatectomy (living liver donors = 4) and 12 to two-stage procedures (portal vein embolization = 4, ALPPS = 8). Overall, 18 patients developed PHLF according to ISGLS criteria: 12 of grade A (no change in the patient’s clinical management) and 6 of grade B (change in clinical management). ROC analysis established increasingly higher cutoffs of FLR-F for predicting PHLF according to the “50–50 criteria”, ISGLS grade B and ISGLS grade A/B, respectively. HBS with SPECT/CT may help to assess severity of PHLF following major hepatectomy. Prospective multicenter trials are needed to confirm the effective role of HBS-SPECT/CT in liver surgery.

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“…The long‐term morbidity associated with organ transplantation in patients with hepatoblastoma, the role of long‐term immunosuppression and potential development of secondary malignancy have not been assessed conclusively. Donor morbidity is important. Despite morbidity remaining low for left lateral segment donation (which forms the majority of grafts in children), there always remains a finite risk of serious complications and mortality.…”

Section: Discussionmentioning

confidence: 99%

Outcomes for high-risk hepatoblastoma in a resource-challenged setting

et al. 2020

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Background: Outcomes of high-risk hepatoblastoma have been dismal, especially in resource-challenged countries where access to chemotherapy and paediatric liver transplantation is limited for the underprivileged. This study aimed to assess the results of treatment of high-risk hepatoblastoma in a tertiary centre, including patients who had non-transplant surgical procedures in the form of extended resection. Methods: A review of patients with high-risk hepatoblastoma treated between January 2012 and May 2018 was carried out. Perioperative data and long-term outcomes were analysed. Results: Of 52 children with hepatoblastoma, 22 were considered to have high-risk hepatoblastoma (8 girls and 14 boys). The mean(s.d.) age at diagnosis was 35(20) months. Of these 22 children, five died without surgery. Of the remaining 17 who underwent surgery, six had a resection (4 right and 2 left trisectionectomies) and 11 underwent living-donor liver transplantation. Median follow-up was 48 (range 12-90) months. Thirteen of the 17 children were alive at last follow-up and four developed disseminated disease (3 had undergone liver transplantation and 1 liver resection). The overall survival rate at 1, 3 and 5 years was 77, 64 and 62 per cent for the whole cohort with high-risk hepatoblastoma. In children who had surgery, 1-, 3-and 5-year survival rates were 91, 82 and 73 per cent for transplantation and 100, 83 and 83 per cent for resection. There was no difference in survival between the two surgical groups. Conclusion: Excellent results in the treatment of high-risk hepatoblastoma are possible, even in resource-challenged countries.

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The Analysis of Posthepatectomy Liver Failure Incidence and Risk Factors Among Right Liver Living Donors According to International Study Group of Liver Surgery Definition

Cited by 5 publications

References 31 publications

Using the Comprehensive Complication Index to Rethink the ISGLS Criteria for Post-hepatectomy Liver Failure in an International Cohort of Major Hepatectomies

Using the Comprehensive Complication Index to Rethink the ISGLS Criteria for Post-hepatectomy Liver Failure in an International Cohort of Major Hepatectomies

The role of hepatobiliary scintigraphy combined with spect/ct in predicting severity of liver failure before major hepatectomy: a single-center pilot study

Outcomes for high-risk hepatoblastoma in a resource-challenged setting

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