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 175 LDHs performed at our institution from January 2011 to December 2014; 79 donors received systemic heparinization (group I), whereas 96 did not, but the liver graft was flushed with a heparinized perfusate (group II). The mean follow-up period was 60.6 ± 24.6 months for group I and 47.1 ± 13.5 months for group II. Patient demographics, intraoperative parameters, postoperative complications, and survival rates were compared between the two groups. The overall complication rates in donors did not differ significantly between the two groups, but postoperative bleeding requiring red blood cell transfusions in donors occurred more frequently in group I versus group II (7.6% versus 1.0%, P = 0.028). The incidences of graft vascular thrombosis were similar in the two groups, and no graft loss caused by vascular thrombosis was evident during the early postoperative period. The incidence of biliary stricture in recipients was not higher in donors who did not receive systemic heparin (5.1% versus 8.3%, P = 0.394). Moreover, the 1-,3-,and 5-year graft survival rates in the group I and group II were 87.1%, 84.5%, 81.9% and 96.9%, 94.7%, 93.6%, respectively and so overall graft survival in group II was higher than that in group I (p=0.018). In conclusion, the omission of systemic heparinization during LDH is both feasible and safe, with no adverse effects on donor or recipient outcomes.