Is Systemic heparinization necessary during living donor hepatectomy?

Abstract

Systemic heparinization has traditionally been performed during living donor hepatectomy (LDH) at most transplant centers because of the possibility of graft vascular thrombosis. However, no consensus on the use of systemic heparinization during LDH has yet emerged. The aims of the present study were to compare donor and recipient outcomes with reference to systemic heparinization and to determine whether or not systemic heparin needs to be administered to living donors. Via a retrospective review, we analyzed the outcomes of 137 LDHs performed at our institution from January 2011 to October 2013; 79 donors received systemic heparinization (group I), whereas 58 did not, but the liver graft was flushed with a heparinized perfusate (group II). Patient demographics, intraoperative parameters, laboratory data, postoperative complications, and survival rates were compared between the 2 groups. The overall complication rates did not differ significantly between the 2 groups, but postoperative bleeding requiring red blood cell transfusions occurred more frequently in group I versus group II (7.6% versus 0.0%, P = 0.03). The incidences of graft vascular thrombosis were similar in the 2 groups, and no graft loss caused by vascular thrombosis was evident during the early postoperative period. Moreover, no difference in either posttransplant graft function or survival was apparent between the 2 groups. The rates of decreases in donor hemoglobin, hematocrit, and platelet count levels during the early postoperative period were significantly higher in group I versus group II. In conclusion, the omission of systemic heparinization during LDH is both feasible and safe, with no adverse effects on donor or recipient outcomes.