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Surgery. 2013 May;153(5):619-26. doi: 10.1016/j.surg.2012.11.020. Epub 2013 Feb 13.

Right hepatectomy for living donation: role of remnant liver volume in predicting hepatic dysfunction and complications.

Author information

1
Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY 10029, USA. marcelo.facciuto@mountsinai.org

Abstract

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 cm(3), which correlated with its actual weight (r = 0.63, P < .01); median RLV was 548 cm(3). 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.

PMID:
23415081
DOI:
10.1016/j.surg.2012.11.020
[Indexed for MEDLINE]

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