Early Liver Support With MARS in Post-hepatectomy Liver Failure

Inclusion Criteria: * Patients subjected for major liver surgery (4 or more Couinaud segments) or patients undergoing a 2nd, 3rd or 4th hepatic resection. Pre-operative chemotherapy and/or biological agents are allowed. * Primary PHLF occurring early after surgery defined by the 50:50 criteria (from PO day 5 to day 14) or by the presence of hepatic encephalopathy grade 2 or more and the 50:50 criteria (from PO day 3 to 4). * Written informed consent. Exclusion Criteria: * ALPPS (Associating Liver Partition and Portal vein Ligation for Staged hepatectomy) procedure. * In patients with chronic liver disease presence of significant portal hypertension (hepatic venous pressure gradient ≥ 10 mmHg and/or Fibroscan ≥ 21kPa) prior to surgical intervention. * Any contraindication for MARS therapy such as uncontrolled active bleeding, platelet counts \<20.000 /µl or uncontrolled infection (presence of fever or adequate antibiotic therapy for less than 48h), septic shock, haemodynamic instability requiring inotropic support (noradrenaline \> 1mg/h). * PHLF occurring after post operative day 14. * Secondary PHLF: post-operative liver failure secondary to vascular (outflow or inflow thrombosis) or septic problems. * Persistant biliary complications (infected biloma, main biliary tree damage). * Inability or unwilling of the patient or family to give informed consent.