Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment

Authors

  • Maartje A. J. Van Den Broek,

    1. Department of Surgery, University Hospital Maastricht, Maastricht, the Netherlands
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  • Steven W. M. Olde Damink,

    1. Department of Surgery, University Hospital Maastricht, Maastricht, the Netherlands
    2. Department of Surgery, University College London Hospital, University College London, London, UK
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  • Cornelis H. C. Dejong,

    1. Department of Surgery, University Hospital Maastricht, Maastricht, the Netherlands
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  • Hauke Lang,

    1. Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
    2. Department of General and Abdominal Surgery, Johannes Gutenberg University Mainz, Mainz, Germany
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  • Massimo Malagó,

    1. Department of Surgery, University College London Hospital, University College London, London, UK
    2. Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
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  • Rajiv Jalan,

    1. Liver Failure Group, Institute of Hepatology, University College London, London, UK
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  • Fuat H. Saner

    1. Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
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Correspondence
Steven W.M. Olde Damink, MD, MSc, PhD, Department of Surgery, University Hospital Maastricht, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
Tel: +31 43 387 7489
Fax: +31 43 387 5473
e-mail: steven.oldedamink@ah.unimaas.nl

Abstract

Liver failure is a dreaded and often fatal complication that sometimes follows a partial hepatic resection. This article reviews the definition, incidence, pathogenesis, risk factors, risk assessment, prevention, clinical features and treatment of post-resectional liver failure (PLF). A systematic, computerized search was performed using key words related to ‘partial hepatic resection’ and ‘liver failure’ to review most relevant literature about PLF published in the last 20 years.

The reported incidence of PLF ranges between 0.7 and 9.1%. An inadequate quantity or quality of residual liver mass are key events in its pathogenesis. Major risk factors are the presence of comorbid conditions, pre-existent liver disease and small remnant liver volume (RLV). It is essential to identify these risk factors during the pre-operative assessment that includes evaluation of liver volume, anatomy and function. Preventive measures should be applied whenever possible as curative treatment options for PLF are limited. These preventive measures intend to increase RLV and protect remnant liver function. Management principles focus on support of end-organ and liver function. Further research is needed to elucidate the exact pathogenesis of PLF and to develop and validate adequate treatment options.

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