Pharmacological Management for Prevention and Treatment of Posthepatectomy Liver Failure.

BACKGROUND: Posthepatectomy liver failure (PHLF) remains a leading cause of morbidity and mortality following major liver resection. Despite advances in surgical techniques and perioperative care, treatment options for PHLF are limited. Pharmacological interventions targeting ischemia-reperfusion injury and portal flow modulation have gained interest as potential therapeutic strategies. SUMMARY: This review provides a clinically applicable overview of the current evidence on pharmacological management of PHLF. Perioperative glucocorticoids may reduce inflammatory complications and lower PHLF incidence, though patient selection is crucial. N-acetylcysteine demonstrates antioxidant effects in experimental models and omega-3 fatty acids reduce inflammation, but both lack clinical efficacy. Somatostatin and terlipressin, which modulate portal hemodynamics, have shown promise in preclinical and early-phase clinical studies; however, randomized trials have yet to confirm their benefit in reducing PHLF. Nonselective β-blockers impair liver regeneration in preclinical models and are not recommended posthepatectomy. Early postoperative heparin administration and hyperinsulinemic-normoglycemic strategies have been associated with reduced PHLF but require further validation. KEY MESSAGES: While perioperative glucocorticoids may reduce PHLF risk in selected patients, other pharmacological agents show theoretical or preliminary promise, but cannot be routinely recommended based on current evidence. Prospective clinical trials are needed to establish effective pharmacological strategies for the prevention and treatment of PHLF.