%0 Journal Article
%T Renal Dysfunction Is an Independent Risk Factor for Mortality after Liver Resection and the Main Determinant of Outcome in Posthepatectomy Liver Failure
%A M. G. Wiggans
%A G. Shahtahmassebi
%A M. J. Bowles
%A S. Aroori
%A D. A. Stell
%J HPB Surgery
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/875367
%X 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 ( ), renal dysfunction ( ), and PHLF on day 5 ( ) 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. 1. Introduction Despite advances in both operative technique and perioperative care liver resection is associated with mortality rates of 0 to 22% (median 3.7%) and morbidity rates of 12.5% to 66% (median 36%) [1] including liver [2, 3] and renal dysfunction [4]. Liver dysfunction is a major contributor to both morbidity and mortality with an incidence between 1.2% and 32% in published series [5¨C12]. Renal dysfunction has also been shown to be associated with mortality following liver resection [13], with a reported incidence between 5 and 15% [4, 14]. Posthepatectomy renal failure may occur in conjunction with liver failure when maldistributive circulatory changes occur causing intravascular hypovolaemia [4, 15] but is also related to operative stress and blood loss [16, 17]. 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£¿¦̀mol/L on the fifth postoperative day, which has been shown to predict liver failure and death after hepatectomy [2]. 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
%U http://www.hindawi.com/journals/hpb/2013/875367/