“Liver resection is used increasingly for the management of a variety of benign and malignant conditions. These data have paralleled substantial advances in perioperative management and operative techniques that have improved the safety of, and extended the indications for, liver resection over the past 2 decades. Extended liver resections, liver resections in diseased liver or liver parenchyma affected by chemotherapy, and repeat
or staged liver resections are being used to achieve curative resection and extend long-term survival. The resulting small functional remnant liver volumes and compromised liver function in these patients increase the risk for the development of posthepatectomy liver failure (PHLF). Despite the introduction of functional and imaging measures to assess preoperatively the size and function of the future liver remnant, as well as the use of
portal vein embolization as a preventive intervention, PHLF remains a major concern and has been shown to be a predominant cause of hepatectomy-related mortality.”

“The development of PHLF is a major cause of postoperative morbidity and mortality after elective hepatic resection. The clinical relevance of PHLF within surgical practice has increased because extended resections are carried out more frequently, even in patients who have received potentially hepatotoxic systemic therapy. With smaller remnant liver volume and impaired functional capacity in some of these patients, there is an increased risk of PHLF. Despite the growing relevance of PHLF in the postoperative management of patients with hepatic resection, there is no standardized definition of this complication.
Our review of the hepatic surgery literature failed to identify a uniform definition of PHLF that has been accepted among hepatobiliary surgeons. In most studies, PHLF was defined by hyperbilirubinemia and/or impaired coagulation using various cut-off values of serum bilirubin concentration and/or INR (prothrombin time/index) at different postoperative time points.”

Rahbari, Nuh N et al. “Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS).” Surgery vol. 149,5 (2011): 713-24. Full Text for Emory Users