Endorsed by IHPBA
Total of 20 separate questions, hence 20 panels
WG1: DEFINITIONS, DIAGNOSIS & MONITORING
Q1. What definition and grading system best defines clinically meaningful post-hepatectomy liver failure?
- ISGLS vs 50–50 and bilirubin/INR-based models
- Clinical relevance of Grade A
- Static vs dynamic definitions
- Reporting standards for Grade B/C and implications for long-term outcome assessment
Q2. Which postoperative prognostic scores and biomarkers best predict short-term mortality in evolving of established post-heptatectomy liver failure?
- Conventional laboratory parameters
- Emerging biomarkers (e.g. lactate, microRNAs)
- Early vs delayed prediction
Q3. Which postoperative monitoring strategies, biomarkers and dynamic trajectories enable early detection of evolving post-hepatectomy liver failure?
- Frequency and timing of laboratory tests
- Role of imaging
- Functional liver tests in the postoperative period
WG2: IMPACT, RISK FACTORS & OUTCOMES
Q4. What is the impact of post-hepatectomy liver failure on short- and long-term clinical outcomes following hepatectomy?
- Mortality and morbidity
- Functional recovery and quality of life
- Organ-based outcomes
- Oncological outcomes, including disease-free and overall survival
Q5. Which baseline patient-related clinical and biological characteristics are associated post-hepatectomy liver failure following hepatectomy?
- Cirrhosis and fibrosis
- Metabolic liver disease (CASH)
- Obesity, diabetes, systemic inflammation
- Chemotherapy-associated liver injury
Q6. How does the underlying indication for hepatectomy influence post-heptatectomy liver failure risk and perioperative decision-making?
- Colorectal liver metastases vs hepatocellular carcinoma vs cholangiocarcinoma
- Simultaneous multiorgan resection vs staged approaches
- Bowel resection combined with major hepatectomy
WG3: PREOPERATIVE ASSESSMENT & PREVENTION
Q7. Which preoperative liver remnant volume and functional assessments best determine safe resection and predict post-hepatectomy liver failure?
- CT/MRI volumetry and elastography
- Dynamic functional tests (ICG clearance, LiMAx, hepatobiliary scintigraphy)
- Definition of safe limits in normal, steatotic, fibrotic, and cirrhotic livers
- Indication-specific FLR thresholds
- Discordance between volumetric and functional assessment
- Assessment of post-augmentation adequacy using volumetric and functional criteria
Q8. What is the effectiveness of preoperative biliary decompression strategies in reducing post-hepatectomy liver failure, and how should bilirubin thresholds guide timing and sequencing of liver resection?
- Bilirubin cut-offs for upfront surgery
- Indications, timing, and modality of biliary drainage
- Impact of biliary decompression on infection risk, treatment delay, and cancer outcomes
- how should these inform decisions to proceed with hepatectomy and the timing and sequencing of cancer surgery
Q9. Which pre-operative future liver remnant augmentation strategies best enable safe hepatectomy and reduce post-hepatectomy liver failure?
- PVE plus hepatic vein embolisation
- ALPPS
- PVE
- HA etc
Q10. Do preoperative optimisation and prehabilitation strategies reduce the risk or severity of post-hepatectomy liver failure following hepatectomy?
- Nutritional optimisation
- BCAA supplementation
- Sarcopenia reversal
Q11. Do pharmacological conditioning strategies reduce liver injury and post-hepatectomy liver failure following hepatic resection?
- Bile acid mimetics
- Regenerative growth factors
- Statin etc
WG4: INTRAOPERATIVE RISK MODULATION & PREDICTION
Q12. Which intraoperative surgical strategies preserve hepatic physiology and functional capacity of the future liver remnant and reduce post-hepatectomy liver failure following hepatectomy?
- Ischaemic preconditioning
- Pringle manoeuvre
- Liver perfusion monitoring (ICG fluorescence)
- Portal pressure measurement and modulation
- Liver transection techniques and thermal damage
Q13. How do anaesthetic and haemodynamic management strategies during hepatectomy influence the incidence of post-hepatectomy liver failure?
- Low-CVP anaesthesia
- Vasopressor use
- Fluid management strategies
Q14. Which intraoperative factors predict the development of post-hepatectomy liver failure following hepatectomy?
- Ischaemia time
- Blood loss and transfusion
- Haemodynamic instability
- FLR performance
WG5: POSTOPERATIVE MANAGEMENT AND RESCUE THERAPIES
Q15. What antimicrobial strategies are effective in preventing infection-related deterioration or managing infection following hepatectomy?
- Prophylactic vs targeted antibiotics
- Antifungal therapy in high-risk patients
Q16. Which supportive intensive care interventions influence clinical trajectories and outcomes in patients with evolving or established post-hepatectomy liver failure?
- Renal replacement therapy
- Nutritional support
- Haemodynamic optimisation
Q17. Which post-operative pharmacological therapies are effective in preventing progression, attenuating severity, or treating post-hepatectomy liver failure?
- N-acetylcysteine
- Albumin
- Terlipressin
- Octreotide
- FXR agonists
Q18. Which extra-corporeal liver support and blood purification therapies are effective in treatment post-hepatectomy liver failure?
- Liver support systems (MARS, ELAD, Prometheus)
- Plasma exchange
- Postoperative portal modulation (e.g. splenic artery embolisation, shunts)
- ICU organ support strategies
Q19. What is the role in rescue liver transplantation in patients with severe post-hepatectomy liver failure?
- Severity and reversibility of PHLF
- Oncological context and prognosis
- Super-urgent listing vs living donor liver transplantation
- Futility, equity, and resource allocation
- WG6: FUTURE DIRECTIONS & RESEARCH PRIORITIES
Q20. What are the key evidence gaps and emerging strategies for improving the prevention, diagnosis, and management of PHLF?
- AI-driven risk prediction and decision-support models
- Novel regenerative therapies (e.g. stem cells, hepatocyte growth factors)
- Bile acid signalling and metabolic modulation
- Gut–liver axis modulation
- Trial design, endpoints, and implementation science gaps