Post-hepatectomy liver failure (PHLF) remains a major source of morbidity, mortality and cost implications in patients undergoing liver resection. A variety of preoperative selection criteria have been used to predict PHLF. However, an early postoperative prognosticator of PHLF remains unavailable to permit the timely intervention and prevention. We aimed to develop a nomogram for predicting PHLF to facilitate early intervention and improvement of clinical outcomes. 

Here, we developed an online calculator for predicting PHLF, incorporating six variables, cirrhosis, preoperative total bilirubin, blood loss in operation, age and two identified serological markers associated with regeneration (VEGFA and PEDF)**. The present calculator is built based on 125 liver resections in our EHBH hospital, and has been validated in an independent cohort containing 117 ones.

This online tool is potentially useful for the timely introduction of aggressive of liver support devices in patients to allow the liver regeneration and prevent PHLF. Moreover, we hope that this model can be externally validated in large independent cohorts.

Please note that the present model did not specify a specific threshold at which adjuvant therapy should be recommended. We believe that the final decision should be made after thoughtful discussion between clinician and patient according actual situation.

*: In this model, major hepatectomy is assessed by resection of two or more liver segments, or resection with more than 10% of the total liver volume exclusive of tumors; PHLF is assessed on the International Study Group of Liver Surgery (ISGLS) definition.

**: Serum PEDF to VEGFA ratio index (SPVRI) has been validated to associate with liver regeneration in our previous study.