Right hepatectomy for living donation: Role of remnant liver volume in predicting hepatic dysfunction and complications.
Facciuto, Marcelo MD, MPH a,∗; Contreras-Saldivar, Alan MD a; Singh, Manoj K. MD, MPH a; Rocca, Juan P. MD a; Taouli, Bachir MD b; Oyfe, Irina MBA c; Rudow, Dianne LaPointe DNP a; Gondolesi, Gabriel E. MD d; Schiano, Thomas D. MD a; Kim-Schluger, Leona MD a; Schwartz, Myron E. MD a; Miller, Charles M. MD e; Florman, Sander MD a
[Article]
Surgery.
153(5):619-626, May 2013.
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Background: Extensive attention has been placed on remnant liver volume (RLV) above other factors to ensure donor safety.
Methods: We performed a retrospective review of 137 right hepatectomies in live donors between June 1999 and November 2010.
Results: Median right lobe volume was 1,029 cm3, which correlated with its actual weight (r = 0.63, P < .01); median RLV was 548 cm3. Of the donors, 32 (24%) developed postoperative hepatic dysfunction (bilirubin >3 mg/dL or prothrombin time >18 s on postoperative day 4). RLV did not predict postoperative hepatic dysfunction (P = .9), but it was associated with peak international normalized ratio (INR) (P = .04). Donor age and male gender were predictors of increased bilirubin at postoperative day 4 (age, P = .03; gender, P = .02). Of the donors, 45 (33%) experienced complications, and 24 donors had RLVs <30%; 42% experienced complications compared to 31% of donors whose RLVs were greater than 30% (P = .3). Cell-saver utilization and aspartate-aminotransferase (AST) levels (OR = 3) were associated with complications. Volumetric assessment can predict RLV accurately.
Conclusion: Although no demonstrable association between RLV <30% and complications was found, an RLV of 30% should remain the threshold for donor safety. Age and gender should be balanced in donors with a near threshold RLV of 30%. Surgical complexity, suggested by the need for intraoperative autoinfusion of blood and postoperative levels of AST, remained the independent predictor of complications.
(C) 2013Elsevier, Inc.
