Post-operative Delayed Elevation of ALT and TB > 57.1 umol/L of Postoperative Day 5 Predict Posthepatectomy Liver Failure of Patients with HBV-related Hepatocellular Carcinoma.

Abstract

Abstract Background Posthepatectomy liver failure (PHLF) remains a life-threatening complication after partial hepatectomy (PH). Nowadays several PHLF criteria have been published, but criteria concerning postoperative delayed elevation of ALT (PDE-ALT) PHLF and fatal PHLF are scant. The aim of study was to evaluate PDE-ALT combined with postoperative serum TBil to predict PHLF patients with HBV-related Hepatocellular Carcinomas in postoperative day (POD) 30. Patients and methods: A cohort study of patients with HBV-related HCC and who developed PHLF in National database of liver cancer samples of Eastern Hepatobiliary Surgery Hospital was classified into two groups (A: Death, B: Survival). Liver function tests were dynamical compared between the two groups using with pearson’s chi-squared test at postoperative days (POD) 1, 3, 5, and 7, ROC-AUC was used to definite the cut-off value of TBil. Results Of the 2620 patients, 156 (6. 0%) developed PHLF in POD 30. The overall incidence of fatal PHL was 0.57% (15/ 2620) in POD 30. The dynamic changes of ALT in and between the two groups in the postoperative 1 week of POD 30 was found statistically significance (P = 0.001, P < 0.001; respectively); PDE-ALT + TBil > 57.1 umol/L predicted the fatal PHLF in Pod 30. (POD 5 AUC = 0.689, P = 0.030). The sensitivity and specificity of “PDE-ALT + TBil > 57.1 umol/L” predicted the fatal PHLF in Pod 30 was 76.9%, 58.0%; respectively; Conclusion “Post-operative Delayed Elevation of ALT and POD 5 TBil > 57.1 umol/L” in patients with HBV-related HCC may predicted the fatal PHLF. Therefore, it is important to monitor them closely for these patients, then initiate early and continue intensive treatment if necessary.