Posthepatectomy liver failure – scoring systems in clinical practice

Czech version

Authors: V. Rekeň; M. Sabol; Š. Nemergut; L. M. A. Rodriguez; D. Šintál; Š. Durdík
Authors‘ workplace: Klinika onkologickej chirurgie LF UK a Onkologický ústav sv. Alžbety, s. r. o., Bratislava
Published in: Gastroent Hepatol 2023; 77(3): 225-230
Category: Hepatology: original article
doi: https://doi.org/10.48095/ccgh2023225

Overview

Introduction: Posthepatectomy liver failure (PHLF) is still a dreaded disease entity despite medical advances. The primary aim of the work was to retrospectively apply selected scoring systems used to assess the risk of PHLF to a group of patients after major liver resections operated at the authors‘ workplace. We anticipate that the latest scoring systems will provide a more accurate picture of PHLF risk. Methods: Between 2007 and 2016, 82 patients meeting the inclusion criteria (elective removal of three or more liver segments for neoplasm) were identified. Five scoring systems were applied to them, namely: “50-50” criterion, ISGLS classification, Hyder score, ALBI and Liu score. Results: Using the “50-50” criterion, none of the patients reached the diagnosis of PHLF. Applying the ISGLS scoring system, 68 patients (86%) had grade “A” and 11 had grade “B” PHLF on the 5^th postoperative day. Hyder‘s score above 11 was achieved by two patients who died on the 14^th and 34^th postoperative day. In the ALBI score, only one patient achieved a value of more than –1.39 (–0.4), while he died on the second postoperative day. Within the Liu score, 55 patients had a predicted very serious risk of developing PHLF, while 46 patients died with an average survival of 27 months after resection. Of the five applied scoring systems, only in the case of ALBI and Liu scores was a statistically significant difference between subgroups of patients with different degrees of presence or prediction of PHLF. A marginally significant difference in the proportion of genders was also noted within the entire set, with men having a higher chance of death (OR 2.63; 95% CI 0.83–8.32). Discussion: The ALBI scoring system correlates with the literature. It has shown very good prediction in several meta-analyses of cohorts of patients after major liver resection. A significantly positive clinical factor of the use of this system is that it is based on preoperative values of laboratory blood tests and can be proposed as a stable prediction model for short-term results after liver resection. Conclusion: The presented scoring systems still represent a rather heterogeneous view of PHLF. Our work points to the ALBI score as the best scoring system. Consistent stratification of patients and treatment in high-volume centers are key pillars of prevention of PHLF.

Keywords:

Hepatectomy – liver failure – scoring systems – liver neoplasm – posthepatectomy liver failure – major liver resection

Sources

1. Hammond JS, Guha IN, Beckingham IJ et al. Prediction, prevention and management of postresection liver failure. Br J Surg 2011; 98 (9): 1188–1200. doi: 10.1002/bjs.7630.

2. Zou H, Yang X, Li QL et al. A Comparative Study of Albumin-Bilirubin Score with Child-Pugh Score, Model for End-Stage Liver Disease Score and Indocyanine Green R15 in Predicting Posthepatectomy Liver Failure for Hepatocellular Carcinoma Patients. Dig Dis 2018; 36 (3): 236–243. doi: 10.1159/000486590.

3. Chan S, Sharr W, Chan A et al. Rescue Livingdonor Liver Transplantation for Liver Failure Following Hepatectomy for Hepatocellular Carcinoma. Liver Cancer 2013; 2 (3–4): 332–337. doi: 10.1159/000343848

4. Balzan S, Belghiti J, Farges O et al. The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 2005; 242 (6): 824–828, discussion 828–829. doi: 10.1097/01.sla.0000189131.90876.9e.

5. Mullen JT, Ribero D, Reddy SK et al. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg 2007; 204 (5): 854–864. doi: 10.1016/ j.jamcollsurg.2006.12.032.

6. Rahbari NN, Reissfelder C, Koch M et al. The predictive value of postoperative clinical risk scores for outcome after hepatic resection: a validation analysis in 807 patients. Ann Surg Oncol 2011; 18 (13): 3640–3649. doi: 10.1245/ s10434-011-1829-6.

7. Rahbari NN, Garden OJ, Padbury R et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 2011; 149 (5): 713–724. doi: 10.1016/j.surg.2010.10.001.

8. Hyder O, Pulitano C, Firoozmand A et al. A risk model to predict 90-day mortality among patients undergoing hepatic resection. J Am Coll Surg 2013; 216 (6): 1049–1056. doi: 10.1016/ j.jamcollsurg.2013.01.004.

9. Fagenson AM, Gleeson EM, Pitt HA et al. Albumin-Bilirubin Score vs Model for End-Stage Liver Disease in Predicting Post-Hepatectomy Outcomes. J Am Coll Surg 2020; 230 (4): 637–645. doi: 10.1016/j.jamcollsurg.2019.12.007.

10. Liu JY, Ellis RJ, Hu QL et al. Post Hepatectomy Liver Failure Risk Calculator for Preoperative and Early Postoperative Period Following Major Hepatectomy. Ann Surg Oncol 2020; 27 (8): 2868–2876. doi: 10.1245/s10434-020-08239-6.

11. Sparrelid E, Olthof PB, Dasari BVM et al. Current evidence on posthepatectomy liver failure: comprehensive review. BJS Open 2022; 6 (6): zrac142. doi: 10.1093/bjsopen/zrac142.

12. Golse N, Bucur PO, Adam R et al. New paradigms in post-hepatectomy liver failure. J Gastrointest Surg 2013; 17 (3): 593–605. doi: 10.1007/s11605-012-2048-6.

13. Kauffmann R, Fong Y. Post-hepatectomy liver failure. Hepatobiliary Surg Nutr 2014; 3 (5): 238–246. doi: 10.3978/j.issn.2304-3881.2014.09.01.

14. Baumgartner R, Gilg S, Björnsson B et al. Impact of post-hepatectomy liver failure on morbidity and short- and long-term survival after major hepatectomy. BJS Open 2022; 6 (4): zrac097. doi: 10.1093/bjsopen/zrac097.

15. Marasco G, Alemanni LV, Colecchia A et al. Prognostic Value of the Albumin-Bilirubin Grade for the Prediction of Post-Hepatectomy Liver Failure: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10 (9): 2011. doi: 10.3390/jcm10092011.

16. Guo G, Lei Z, Tang X et al. External Validation of Six Liver Functional Reserve Models to predict Posthepatectomy Liver Failure after Major Resection for Hepatocellular Carcinoma. J Cancer 2021; 12 (17): 5260–5267. doi: 10.7150/jca.58726.

17. Pang Q, Zhou S, Liu S et al. Prognostic role of preoperative albumin-bilirubin score in posthepatectomy liver failure and mortality: a systematic review and meta-analysis. Updates Surg 2022; 74 (3): 821–831. doi: 10.1007/s13304-021-01080-w.

18. Zou H, Wen Y, Yuan K et al. Combining albumin-bilirubin score with future liver remnant predicts post-hepatectomy liver failure in HBV-associated HCC patients. Liver Int 2018; 38 (3): 494–502. doi: 10.1111/liv.13514.

19. Park HJ, Seo KI, Kim SJ et al. Effectiveness of Albumin-bilirubin Score as a Predictor of Post-hepatectomy Liver Failure in Patients with Hepatocellular Carcinoma. Korean J Gastroenterol 2021; 77 (3): 115–122. doi: 10.4166/kjg.2020.148.

20. Takahashi K, Gosho M, Kim J et al. Prediction of Posthepatectomy Liver Failure with a Combination of Albumin-Bilirubin Score and Liver Resection Percentage. J Am Coll Surg 2022; 234 (2): 155–165. doi: 10.1097/XCS.0000000000000027.

21. Laca L, Urdzik J, Dobrota FM et al. Limitácie resekcií pecene. Rozhl Chir 2009; 88 (3): 127–132.