Hepatectomy For Liver Transplantation Research Articles

Recipient hepatectomy technique may affect oncological outcomes of liver transplantation for hepatocellular carcinoma.

To date, caval sparing (CS) and total caval replacement (TCR) for recipient hepatectomy in liver transplantation (LT) have been compared only in terms of surgical morbidity. Nonetheless, the CS technique is inherently associated with an increased manipulation of the native liver and later exclusion of the venous outflow, which may increase the risk of intraoperative shedding of tumor cells when LT is performed for HCC. A multicenter, retrospective study was performed to assess the impact of recipient hepatectomy (CS vs. TCR) on the risk of posttransplant HCC recurrence among 16 European transplant centers that used either TCR or CS recipient hepatectomy as an elective protocol technique. Exclusion criteria comprised cases of non-center-protocol recipient hepatectomy technique, living-donor LT, HCC diagnosis suspected on preoperative imaging but not confirmed at the pathological examination of the explanted liver, HCC in close contact with the IVC, and previous liver resection for HCC. In 2420 patients, CS and TCR approaches were used in 1452 (60%) and 968 (40%) cases, respectively. Group adjustment with inverse probability weighting was performed for high-volume center, recipient age, alcohol abuse, viral hepatitis, Child-Pugh class C, Model for End-Stage Liver Disease score, cold ischemia time, clinical HCC stage within Milan criteria, pre-LT downstaging/bridging therapies, pre-LT alphafetoprotein serum levels, number and size of tumor nodules, microvascular invasion, and complete necrosis of all tumor nodules (matched cohort, TCR, n = 938; CS, n = 935). In a multivariate cause-specific hazard model, CS was associated with a higher risk of HCC recurrence (HR: 1.536, p = 0.007). In conclusion, TCR recipient hepatectomy, compared to the CS approach, may be associated with some protective effect against post-LT tumor recurrence.

Temporary Portocaval Shunt Provides Superior Intraoperative Hemodynamics and Reduces Blood Loss and Duration of Surgery in Live Donor Liver Transplantation: A Randomized Control Trial.

To compare intraoperative hemodynamic parameters, blood loss, renal function, and duration of surgery with and without temporary portocaval shunt (TPCS) in live donor liver transplantation (LT) recipients. Secondary objectives were postoperative early graft dysfunction, morbidity, mortality, total intensive care unit, and hospital stay. Blood loss during recipient hepatectomy for LT remains a major concern. Routine use of TPCS during LT is not yet elucidated. This study is a single-center, open-label, randomized control trial. The sample size was calculated based on intraoperative blood loss. After exclusion, a total of 60 patients, 30 in each arm (TPCS vs no TPCS) were recruited in the trial. The baseline recipient and donor characteristics were comparable between the groups. The median intraoperative blood loss ( P = 0.004) and blood product transfusions ( P < 0.05) were significantly less in the TPCS group. The TPCS group had significantly improved intraoperative hemodynamics in the anhepatic phase as compared with the no TPCS group ( P < 0.0001), requiring significantly less vasopressor support. This led to significantly better renal function as evidenced by higher intraoperative urine output in the TPCS group ( P = 0.002). Because of technical simplicity, the TPCS group had significantly fewer inferior vena cava injuries (3.3 vs 26.7%, P = 0.026) and substantially shorter hepatectomy time and total duration of surgery (529.4 ± 35.54 vs 606.83 ± 48.13 min, P < 0.0001). The time taken for normalization of lactate in the immediate postoperative period was significantly shorter in the TPCS group (median, 6 vs 13 h; P = 0.04). Although postoperative endotoxemia, major morbidity, 90-day mortality, total intensive care unit, and hospital stay were comparable between both groups, tolerance to enteral feed was earlier in the TPCS group. In live donor LT, TPCS is a simple and effective technique that provides superior intraoperative hemodynamics and reduces blood loss and duration of surgery.

Initial experience of pure laparoscopic living donor right hepatectomy for liver transplantation

Initial experience of pure laparoscopic living donor right hepatectomy for liver transplantation

The accuracy of Pleth Variability Index for directed fluid optimization in donors in living donor liver transplantation

BackgroundFluid management strongly affects hepatic resection and aims to reduce intraoperative bleeding during living donation. The Pleth Variability Index (PVI) is a tool to assess the fluid responsiveness from the pulse oximeter waveform; we evaluated the efficacy and accuracy of finger PVI compared to pulse pressure variation (PPV) from arterial waveform in predicting the fluid response in donor hepatectomy patients with the guide of non-invasive cardiac output (CO) measurements. We recruited forty patients who were candidates for right lobe hepatectomy for liver transplantation under conventional general anesthesia methods. During periods of intraoperative hypovolemia not affected by surgical manipulation, PVI, PPV, and CO were recorded then compared with definitive values after fluid bolus administration of 3–5 ml/kg aiming to give a 10% increase in CO which classified the patients into responders and non-responders.ResultsBoth PPV and PVI showed a significant drop after fluid bolus dose (P < 0.001) leading to an increase of the CO (P < 0.0001), and the area under the curve was 0.934, 0.842 (95% confidence interval, 0.809 to 0.988, 0.692 to 0.938) and the standard error was 0.0336, 0.124, respectively. Pairwise comparison of PPV and PVI showed non-significant predictive value between the two variables (P = 0.4605); the difference between the two areas was 0.0921 (SE 0125 and 95% CI − 0.152 to 0.337).ConclusionsPVI is an unreliable indicator for fluid response in low-risk donors undergoing right lobe hepatectomy compared to PPV. We need further studies with unbiased PVI monitors in order to implement a non-invasive and safe method for fluid responsiveness.

LigaSure versus monopolar cautery for recipient hepatectomy in liver transplantation: a propensity score-matched analysis.

BackgroundRecipient hepatectomy during liver transplantation (LT) is one of the most challenging aspects of surgery due to the possibility of massive bleeding. This study aimed to compare and analyze the effectiveness between LigaSure and monopolar cautery in recipients.MethodsWe reviewed 187 recipients who underwent LT from March 2019 to June 2020. We compared the surgical outcomes of the 69 recipients who underwent recipient hepatectomy with LigaSure (LigaSure group) and 118 recipients who underwent with monopolar cautery. Propensity score matching (PSM) was performed using the nearest-neighbor method at a ratio of 1:1 based on 14 baseline characteristics and possible factors that influence postoperative bleeding.ResultsA total of 187 adult recipients were reviewed retrospectively. In the propensity score-matched analysis, The rates of bleeding and infectious complication were significantly lower in the LigaSure group than in the monopolar cautery group (3/69, 4.35% versus 13/69, 18.8%; P=0.015 and 1/69, 1.45% versus 9/69, 13.0%; P=0.017). The length of postoperative hospital stay was shorter in the LigaSure group (mean: 23.1±16.1 versus 39.6±58.2 days; P=0.024).ConclusionsRecipient hepatectomy with LigaSure is associated with a short hospital stay due to low re-operation rates, postoperative bleeding, and secondary infection related to bleeding.

LigaSure versus monopolar cautery for recipient hepatectomy in liver transplantation: A propensity score-matched analysis

The recipient hepatectomy process during liver transplantation is one of the most challenging parts of surgery because massive bleeding may be expected. The energy device has an excellent hemostatic effect with the sealing effect compared to the monopolar cautery. The purpose of this study was to compare and analyze the usefulness of the energy device with monopolar cautery in liver transplantation. We reviewed those who underwent liver transplantation from March 2019 to June 2020. A total of 187 recipients who underwent liver transplantation were included in this study. Sixty-nine cases of recipient who underwent recipient hepatectomy with LigaSure 118 cases included as a control group. We used propensity score matching to adjust baseline characteristics and possible factor that affects postoperative bleeding. Blood loss and total amounts of RBC transfusion were not different between both groups (mean, 5,486.5 ± 9,024.6 vs. 4,754.3 ± 6,819.5 cc; p = 0.592; 11.01 ± 13.75 vs. 10.21 ± 12.52 pack; p = 0.447). The rates of bleeding and infectious complication were significantly lower in the LigaSure group than in the monopolar cautery group (3/69, 4.35% vs. 13/69, 18.8%; p = 0.015 and 1/69, 1.45% vs. 9/69, 13.0%; p = 0.017). The length of postoperative hospital stay was shorter in the LigaSure group (mean, 23.1 ± 16.1 vs. 39.6 ± 58.2 days; p = 0.024). Recipient hepatectomy using the LigaSure energy device had a shorter hospital stay due to fewer re-operations rate and postoperative bleeding. And it also had fewer secondary complications related to bleeding than the conventional monopolar cautery group.

An Alternative Surgical Technique of Native Hepatectomy in Liver Transplantation

BackgroundOrthotopic liver transplantation has become the procedure of choice for end-stage liver disease. There are 3 commonly used methods of vena cava anastomosis. Here, we report a new technique for native hepatectomy.Material/MethodsThe data of 12 patients who underwent orthotopic liver transplantation using a new surgical technique were retrospectively collected for analysis. The new separation and reconstruction surgical technique mainly involved the second portal isolation and hepatectomy that followed. We performed recipient liver resection without the occlusion of the inferior vena cava, which was then followed by classic, piggyback, modified piggyback, or side-to-side orthotopic liver transplantation. The graft function index and complications were collected after transplantation.ResultsThe length of the anhepatic phase was 30.92±9.1 min. Alanine transaminase (ALT) levels were 138 to 2027 U/L, with a median of 361.5 U/L. The ALT levels of all patients gradually decreased to normal levels 7 to 10 days after surgery. Only 2 recipients had elevated levels of ALT higher than 1000 U/L. Four of 12 patients did not require red blood cell transfusion during surgery. Four patients appeared to have early allograft dysfunction, while others recovered smoothly.ConclusionsThis new surgical technique may shorten the anhepatic phase and decrease blood loss volume, aiding the success of liver transplant surgery. It can be used for most patients and does not increase the risk of complications or impair prognosis.

Pneumoperitoneum-induced pneumothorax during laparoscopic living donor hepatectomy: a case report

BackgroundWe present a living donor case with an unexpected large-volume pneumothorax diagnosed using lung ultrasound during a laparoscopic hepatectomy for liver transplantation (LT).Case presentationA 38-year-old healthy female living donor underwent elective laparoscopic right hepatectomy. The preoperative chest radiography (CXR) and computed tomography images were normal. The surgery was uneventfully performed with tolerable CO2 insufflation and the head-up position. SpO2 decreased and airway peak pressure increased abruptly after beginning the surgery. There were no improvements in the SpO2 or airway pressure despite adjusting the endotracheal tube. Eventually, lung ultrasound was performed to rule out a pneumothorax, and we verified the stratosphere sign as a marker for the pneumothorax. The surgeon was asked to temporarily hold the surgery and cease with the pneumoperitoneum. Portable CXR verified a large right pneumothorax with a small degree of left lung collapse; thus, a chest tube was inserted on the right side. The hemodynamic parameters fully recovered and were stable, and the surgery continued laparoscopically. The surgeon explored the diaphragm and surrounding structures to detect any defects or injuries, but there were no abnormal findings. The postoperative course was uneventful, and a follow-up CXR revealed complete resolution of the two-sided pneumothorax.ConclusionThis living donor case suggests that a pneumothorax can occur during laparoscopic hepatectomy due to the escape of intraperitoneal CO2 gas into the pleural cavity. Because missing the chance to identify a pneumothorax early significantly decreases the safety for living donors, point-of-care lung ultrasound may help attending physicians reach the final diagnosis of an intraoperative pneumothorax more rapidly and to plan the treatment more effectively.

Donor Safety for Minimal invasive Hepatectomy in Liver transplantation;The Korean Organ Transplantation Registry

Donor Safety for Minimal invasive Hepatectomy in Liver transplantation;The Korean Organ Transplantation Registry

Donor safety for minimal invasive hepatectomy in liver transplantation: the Korean Organ Transplantation Registry

Background: The most important concern in living donor liver transplantation (LDLT) is donor safety. Although minimally invasive living donor surgery has been increasingly accepted, its safety remains to be fully clarified in a large-scale study. This study evaluated the safety and effectiveness of minimal invasive living donor hepatectomy in comparison with conventional open procedure using Korean Organ Transplantation Registry data. Methods: We reviewed the prospectively collected data of all 1694 living liver donors who underwent procedures between April 2014 and December 2017. We allocated the donors to a minimal invasive group (MIG, n = 304) and a open group (OG, n = 1390) and analyzed the relations clinical data and complications. Results: The median follow-up was 31 months. During the study period, 1071 men and 623 women donated livers and there were no deaths after living liver donation. The overall complication rates were 7.3% and 4.5% in the two group. (p = 0.43) In the MIG, the AST level at I year after donation was lower than OG (20.4 ± 5.5 mg/dL versus 22.4 ± 9.1 mg/dL, p = 0.003) On the hand, the total bilirubin level at 6 months after donation was higher (0.84 ± 0.39 mg/dL versus 0.74 ±0.36 mg/dL, P < 0.001)The MIG was shorter than OG in duration of hospitalization. (9.04 ± 3.78 days versus 10.29 ± 4.01 days, p < 0.001) Conclusions: The minimal invasive donor hepatectomy was relatively some higher complication rate which was no statistically significant difference but lower duration of hospitalization in compare to conventional open procedure in our study.

SEALIVE: the use of technical vessel-sealing devices for recipient hepatectomy in liver transplantation: study protocol for a randomized controlled trial

BackgroundThe surgical technique used in liver transplantation has undergone constant evolution in an effort to develop a safe, highly standardized procedure. Despite this, the initial step of recipient hepatectomy has not been the focus of clinical research thus far. Due to advanced coagulopathy in liver transplant recipients, this part of the operation still carries the risk of severe hemorrhage. This trial is designed to compare an electrothermal bipolar vessel sealing device (LigaSure™) and an ultrasound dissector (HARMONIC ACE®+7) with standard surgical techniques during the recipients’ hepatectomy in liver transplantation.Methods/designIn a single-center, prospective, randomized, controlled, parallel, three-armed, confirmatory, open trial, LigaSure™ and HARMONIC ACE®+7 will be compared with standard surgical techniques that use titanium clips and conventional knot-tying ligations during recipient hepatectomy in liver transplantation. Intraoperative total blood loss is the primary endpoint of the trial. Secondary endpoints include blood loss during hepatectomy, the duration of both the hepatectomy and the entire surgical procedure, and blood transfusion requirements of the procedure. To generate reliable data, intraoperative blood loss will be recorded with respect to all rinse fluids during surgery, ascites, and by weighing used swabs. At 80% power and an alpha of 0.025 for both of the experimental groups, 23 subjects will be analyzed per protocol in each study arm in order to detect clinically relevant reduction of intraoperative blood loss. The intention-to-treat analysis will include 69 patients. The follow-up period for each patient will be 90 days for safety reasons, whereas all clinical outcomes will be measured within the first 10 postoperative days.DiscussionTo our knowledge, this is the first prospective, randomized trial comparing two innovative technical methods of vessel sealing and dissection with standard techniques for recipient hepatectomy. This will be done to detect relevant reduction of intraoperative blood loss during liver transplant. The results of the trial are expected to improve patient outcome and safety after liver transplant and to increase the general safety of this procedure.Trial registrationClinicalTrials.gov, NCT 03323242. Registered on October 26, 2017.

Surgery for primary liver malignancies – innovations and limitations

Primary liver malignancies mainly arise from hepatocytes or bile duct cells. They become clinically evident as hepatocellular carcinomas (HCCs) and intrahepatic or hilar cholangiocarcinoma (CC). The treatment of these tumours is based on an interdisciplinary, multimodal approach, in which surgery has a major role. As techniques have improved, more patients can undergo safe operations, including extended resections and vascular reconstructions. In the case of an expected critical liver remnant after surgery, techniques before or during surgery can be used to induce liver hypertrophy, which reduces postoperative liver failure. There is ongoing discussion about whether resection or transplantation in cirrhotic livers is preferred in patients with HCCs. Patients with cholangiocarcinomas should undergo transplantation only within clinical trials. A neoadjuvant treatment protocol (Mayo Clinic protocol) that improves surgical outcome in patients with hilar CCs has been established. Nevertheless, criteria to predict good outcome of liver transplantation in patients HCCs and CCs exist and should be respected. Recent innovations in liver surgery are minimally invasive procedures. The innovative approach of robotic-assisted operations is a technical upgrade to conventional laparoscopy. These methods enable experienced surgeons to perform nearly all types of surgery, including living donor hepatectomy for liver transplantation. The oncological outcomes after minimally invasive liver resection are comparable to those of open procedures. For most patients surgery remains the only chance for complete cure and therefore it is still the most commonly performed procedure for primary liver tumour treatment. New innovative techniques will support the impact of surgery in the future.

A comparative study of the classic and piggyback techniques for orthotopic liver transplantation.

Background:The classic technique of hepatectomy with venovenous bypass may cause a longer anhepatic phase and increase the rate of some complications, such as post-operative renal failure and thromboembolic events. But, in some cases, such as tumors and anatomic difficulties, the surgeon is obligated to use the classic technique even though there is some controversy about the safety of this technique without venovenous bypass in liver transplantation. The aim of this study was to compare the results of using the classic technique without venovenous bypass and the piggyback technique for liver transplantation.Methods:A retrospective case-series study was conducted on 227 consecutive successful liver transplants, including 55 cases in which the classic technique was used and 172 cases in which the piggyback technique was used. The transplants were performed from March 2010 through June 2011 in the Visceral Transplantation Ward at Namazi Hospital in Shiraz, Iran. The piggyback method was the preferred approach for hepatectomy, but the classic technique without venovenous bypass was performed in cirrhotic cases with anatomic difficulties, when there was a tumor, or when the surgeon preferred it.Results:There were no significant differences in post-operative rise in creatinine, decreases in intraoperative blood pressure, transfused packed red blood cells (RBC), or survival rates between the groups. Warm ischemic time (duration that donor liver is out of ice until it’s blood reperfusion in the recipient) was approximately seven minutes longer in the classic group (P = 0), but it was less than 52 minutes, which is an acceptable time for this phase. Hospital stays were shorter in the classic group than in the piggyback group (P = 0.024).Conclusion:Although the piggyback technique is the preferred technique for hepatectomy in liver transplantation, the classic technique without venovenous bypass can be used safely in cirrhotic livers when necessary or if the physician prefers it.

The left-to-right approach during difficult total hepatectomy for liver transplantation: a safe strategy for challenging cases

The left-to-right approach during difficult total hepatectomy for liver transplantation: a safe strategy for challenging cases

Efficiency of the LigaSure Vessel Sealing System for Recipient Hepatectomy in Liver Transplantation

BackgroundAlthough the LigaSure device is widely used, its use in liver transplantation, where compounding factors of portal hypertension, coagulopathy, and thrombocytopenia exist, is poorly described. MethodsFrom October 1, 2011, to December 31, 2011, 6 patients underwent liver transplantation with recipient hepatectomy utilizing the LigaSure device. Outcomes using the device were compared with 6 contemporaneous patients in whom the device was not used. ResultsPatient demographics, preoperative laboratory values, and Model for End-Stage Liver Disease scores were not different. Recipient hepatectomy was performed, on average, 43 minutes faster using the LigaSure device (P = .02). Although total operative time and intraoperative blood product usage were lower when the LigaSure was used, these differences did not attain statistical significance. Duration of stay and recipient readmission rates were similar. ConclusionsLigaSure vessel sealing is an efficient method for recipient hepatectomy in liver transplantation. Vessel sealing of caval, portal, and other structures can be safely performed in the setting of end-stage liver disease.

Improved Efficiency of LigaSure Vessel Sealing System for Recipient Hepatectomy in Liver Transplantation

Vessel sealing devices expedite surgical procedures by the reliable sealing and dividing of vessels in one action that otherwise require multiple steps for ligation and division. Although the LigaSure device is widely used, its use in liver transplantation where compounding factors of portal hypertension, coagulopathy, and thrombocytopenia exist is poorly described. Methods: From October 1, 2011 to December 31, 2011, six patients underwent liver transplantation with recipient hepatectomy utilizing the LigaSure device for piggyback technique transplantation. Perioperative and intraoperative outcomes using the device were compared to six contemporaneous patients in whom the device was not used. Results: Patient demographics and pre-operative laboratory values and MELD scores were not significantly different. Recipient hepatectomy was performed, on average, 43 minutes faster using the LigaSure device (p = 0.02). Thermal spread was not observed to damage vascular structures. Although total operative time and intraoperative blood product usage were lower when the LigaSure was used, these differences did not reach statistical significance. Conclusions: LigaSure vessel sealing is an efficient method for recipient hepatectomy in liver transplantation. Vessel sealing of caval, portal, and other structures can be safely performed in the settings of end stage liver disease.

Usefulness of the Pinch-Burn-Cut (PBC) technique for recipient hepatectomy in liver transplantation.

Backgrounds/AimsSurgical bleeding during recipient hepatectomy is a major concern in liver transplantation (LT). Effective intraoperative control of bleeding is necessary. In the Pinch-Burn-Cut (PBC) technique, a small amount of tissue around the dissection plane is pinched with forceps, electocauterized and gently cut. The present study sought to estimate the usefulness of the PBC technique in LT.MethodsBetween June 2007 and December 2010, 123 adult cases underwent LT in our center. Of these, 72 involved a recipient hepatectomy using the PBC technique (PBC group). and 51 involved the conventional technique (non-PBC group). Clinical parameters were compared between two groups.ResultsThe amount of blood loss and related transfusions were significantly reduced, and the operating time was shorter in the PBC group than in the non-PBC group (p=0.006, p<0.05 and p=0.002, respectively). There was also shorter duration of mechanical ventilation after LT in the PBC group (p=0.017). The incidence of postoperative hemorrhage was lower in the PBC group than in the non-PBC group, but had no statistical significance between two group (19.6% vs. 8.3%, p=0.101).ConclusionsOur data suggest that the PBC technique is effective for bleeding control during recipient hepatectomy in LT.

Necrosis Percentage of Radiologically Treated Hepatocellular Carcinoma at Hepatectomy for Liver Transplantation

Among a cohort of 414 liver transplantations (OLT) performed form 1996 to 2009, we analyzed 86 patients (20.7%) who were affected by hepatocellular carcinoma (HCC) superimposed on cirrhosis, including 82 with a preoperative diagnosis of tumor; 4 cases had the diagnosis established upon histologic examination after hepatectomy. The gender of 75 patients was male (91.5%), and female in 7 cases (8.5%). The median Model for End-Stage Liver Disease score was 10 (range, 6–23). The underlying liver disease was hepatitis C virus (HCV)-related cirrhosis (41.46%), hepatitis B virus (HBV)-related cirrhosis (15.6%), or alcohol-related cirrhosis (29.3%); cryptogenic; HCV+HIV; HBV+HIV; or HCV+HBV+HIV cirrhosis were present in an other few patients. The diagnosis of HCC and the preoperative staging were defined through radiologic evaluations, without biopsy confirmation in any case. All patients underwent pretransplant radiologic treatments to reduce the drop-out risk while a waiting OLT; OLT was performed for HCC patients within the Milan criteria. Upon histologic examination, the median HCC necrosis was 57 ± 36%; in 22 cases (26.8%), there were no necrotizing effects. Forty patients (48.8%) display a satisfying degree of disease control with 26 patients (31.7%) downstaged effect; 15 patients (18.3%) showed neoplastic progression with advanced neoplastic disease exceeding the Milan criteria at hepatectomy. One patient had nonevaluable necrosis (1.2%). Our experience showed preoperative radiologic treatments to be not curative but serving as a bridge to OLT.

Lactate and liver function tests after living donor right hepatectomy: a comparison of solutions with and without lactate

Hyperlactatemia can predict the prognosis of patients undergoing liver resection. The effects of lactated Ringer's solution on liver function have not been evaluated in patients undergoing major liver resection. We therefore compared the effects of two different crystalloid solutions, with and without lactate, on liver function test data and serum lactate level in living donors undergoing right hepatectomy. A total of 104 donors undergoing right hepatectomy for liver transplantation were randomly allocated to receive lactated Ringer's (LR) solution (n=52) or Plasmalyte (n=52). Anesthetic and fluid management were standardized. Acid-base status, lactate concentration, and liver function tests were analyzed at predetermined time points during the first 5 post-operative days. The lactate concentrations were significantly higher in the LR group than in the Plasmalyte group 1 h after hepatectomy [4.2 (3.2-5.7) vs. 3.3 (2.6-4.6) mmol/l; P=0.005, median (interquartile ranges)]. In addition, the nadir concentration of albumin was significantly lower and the peak total bilirubin concentration and prothrombin time were significantly higher in the LR group compared with the Plasmalyte group. However, these changes in the LR group subsided within the first or second post-operative days, without apparent complications or prolongation of hospital stay. Post-operative peak concentrations of lactate were not correlated with nadir albumin concentration, peak bilirubin, or peak prothrombin time, in either group. This prospective randomized study showed that non-lactate-containing crystalloid solution may have important advantages over LR solution, concerning lactate and liver profiles, in living donors undergoing right hepatectomy.

Extent of right hepatectomy determines postoperative donor albumin and bilirubin changes: new insights

Changes in donor plasma albumin (Alb) and bilirubin (Tbili) are common following right hepatectomy for liver transplantation. We conducted a retrospective study to determine whether the size of the liver resection and the estimated blood loss (EBL) impact these laboratory values in the first week (early) and third week (late) postoperatively. Demographics and peri-operative data of 34 donors undergoing right hepatectomy were analysed by Spearman's correlation (data in means+/-SD, P<0.05=statistically significant). Re-admissions for pleural effusions were tracked. Donors were 26-56 (43.3+/-9.1) years old, body mass index (kg/m(2)) was 27.7+/-4.2, liver resected (%) was 58+/-7 and EBL (mL) was 1505+/-927. A larger hepatectomy correlated with lower Alb at 3 weeks (P=0.03) and also with a higher early (P=0.025) and late Tbili (P=0.037). Larger blood loss determined low Alb in the first week (P=0.013), still noticeable 3 weeks postoperatively (P=0.047). Re-admissions for pleural effusion were not associated with the size of the liver resection or postoperative Alb changes. A remaining liver size-dependent reduced synthetic hepatic function may explain the persistent low Alb that becomes apparent at end of the preoperative Albs half-life. A size-related diminished metabolic liver capacity results in early and late elevated Tbili. Prospective studies are needed to better understand the impact of resection size on hepatic physiology, donor care and clinical outcomes.