The ISGLS (International Study Group of Liver Surgery) defines post-hepatectomy liver failure (PHLF) using the '50-50 criteria' on postoperative day 5. These criteria are:

• A Serum albumin <25 g/L AND bilirubin >50 μmol/L on day 5
• B Bilirubin >50 μmol/L AND PT <50% (INR >1.7) on day 5 ✓
• C Prothrombin time >50 seconds AND serum bilirubin >50 mg/dL on day 5
• D Bilirubin >50 μmol/L AND ascites output >500 mL/day on day 5

Explanation

The 50-50 criteria (Balzan, 2005) define PHLF as the combination of prothrombin activity <50% (equivalent to PT ratio >1.7 or INR >1.7) AND serum bilirubin >50 μmol/L (approximately 2.9 mg/dL) on postoperative day 5 — a simple, validated bedside tool that predicts mortality >50% with good specificity. The ISGLS subsequently defined PHLF grades A–C based on clinical impact. Future liver remnant (FLR) volume assessment and portal vein embolisation are used preoperatively to prevent PHLF.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.