The anesthesia management in adult-to-adult living-donor liver transplantation

Abstract

Objective To evaluate the effect of anesthesia managements in the donor’s operation of adult-to-adult living-donor liver transplantation(A-ALDLT). Methods Anesthesia managerents in hepatectomy of 18 A-ALDLT donors from liver transplant center in the Third Affiliated Hospital of Sun Yat-sen University from May 2007 to September 2008, were analyzed prospectively. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. Application of controlled low central venous pressure(CVP), stablization of circulation, blood auto-transfusion, low dose systematic heparinization and hepatorenal function protection were used in the 18 donors. The operation time, blood loss, urine volume, transfusion volume and the operative procedures were observed and recored. The operation was devided into 5 time points, after anesthesia and before operation, 1, 2, 3 h after hepatectomy, before abdomen-closing. Heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP), CVP, hematocrit(HCT) as well as activated clotting time(ACT) were monitored. The levels of alanine aminotransferase(ALT), albumin(ALB), total bilirubin(TB) and serum creatinine(Scr) were measured preoperation and 1,3,7,14 days postoperaion. One-way anova was applied to analyze the SBP, DBP, HR, CVP, HCT, ACT, ALT, ALB, TB, Scr of every time point. Student-Newman-Keuls statistical method was applied to analyze the group comparison. Results All donors recovered smoothly. The average operation time was (526±106)min and the blood loss was (842±285)ml. The average urine volume was (1 558±442)ml. The auto-transfusion blood was (417±84)ml. The HR, blood pressure(BP) were stable during the operation. The CVP dropped markedly 1, 2 and 3 h after hepatectomy, compared with preoperation. There was significant difference (P<0.05) . The average HCT was 0.33±0.03 after blood autotransfusion but before abdominal closure, which mildly decreased but still within the normal range. The ACT increased markedly 5 minutes later after low dose heparinization and recovered to baseline level after the application of protamine. Mild liver function damage was observed after operation and recovered to normal 2 weeks later. The renal function remained unchanged. All the donors recovered smoothly and discharged. Conclusions In the donor’s operation of A-ALDLT, anesthesia management including controlled low CVP, stabilization of circulation, blood autotransfusion, low dose heparinization and hepatorenal function protection are very important for donor safety. Key words: Liver transplantation; Living donor; Anesthesia; Central venous pressure; Heparinization; Blood autotransfusion; Liver function; Renal function