Renal Dysfunction Is an Independent Risk Factor for Mortality after Liver Resection and the Main Determinant of Outcome in Posthepatectomy Liver Failure

M G Wiggans,D A Stell,G Shahtahmassebi,M J Bowles,S Aroori

doi:10.1155/2013/875367

Abstract

Introduction. The aim of this study was to assess the interaction of liver and renal dysfunction as risk factors for mortality after liver resection. Materials and Methods. A retrospective analysis of 501 patients undergoing liver resection in a single unit was undertaken. Posthepatectomy liver failure (PHLF) was defined according to the International Study Group of Liver Surgery (ISGLS) definition (assessed on day 5) and renal dysfunction according to RIFLE criteria. 90-day mortality was recorded. Results. Twenty-three patients died within 90 days of surgery (4.6%). The lowest mortality occurred in patients without evidence of PHLF or renal dysfunction (2.7%). The mortality rate in patients with isolated PHLF or renal dysfunction was 20% compared to 45% in patients with both. Diabetes (P = 0.028), renal dysfunction (P = 0.030), and PHLF on day 5 (P = 0.011) were independent predictors of 90-day mortality. Discussion. PHLF and postoperative renal dysfunction are independent predictors of 90-day mortality following liver resection but the predictive value for mortality is significantly higher when failure of both organ systems occurs simultaneously.

Highlights

The aim of this study was to assess the interaction of liver and renal dysfunction as risk factors for mortality after liver resection
Postoperative liver dysfunction has been defined by the “50-50 criteria” as a prothrombin index of less than 50% (mean normal prothrombin time (PT) divided by patient’s observed PT) and a serum bilirubin of >50 μmol/L on the fifth postoperative day, which has been shown to predict liver failure and death after hepatectomy [2]
The principle findings of this study are that Posthepatectomy liver failure (PHLF) on postoperative days (POD) 5 as defined by the International Study Group of Liver Surgery (ISGLS) and postoperative renal dysfunction are independent predictors of 90-day mortality following liver resection

Summary

Introduction

The aim of this study was to assess the interaction of liver and renal dysfunction as risk factors for mortality after liver resection. More recently posthepatectomy liver failure (PHLF) has been defined by the International Study Group of Liver Surgery (ISGLS) as a postoperatively acquired deterioration in the ability of the liver to maintain its synthetic, excretory, and detoxifying functions, characterized by an increased INR (or need of clotting factors to maintain normal INR) and hyperbilirubinaemia on or after postoperative day five [18]. The ability of this newer definition of PHLF, using lower measures of dysfunction, to predict mortality has not been thoroughly assessed

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