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

Marcelo Facciuto, Alan Contreras-Saldivar, Manoj K. Singh, Juan P. Rocca, Bachir Taouli, Irina Oyfe, Dianne Lapointe Rudow, Gabriel E. Gondolesi, Thomas D. Schiano, Leona Kim-Schluger, Myron E. Schwartz, Charles M. Miller, Sander Florman

Research output: Contribution to journalArticle

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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 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.

Original languageEnglish (US)
Pages (from-to)619-626
Number of pages8
JournalSurgery (United States)
Volume153
Issue number5
DOIs
StatePublished - May 2013
Externally publishedYes

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Hepatectomy
Liver
Aspartate Aminotransferases
Safety
International Normalized Ratio
Prothrombin Time
Bilirubin
Weights and Measures

ASJC Scopus subject areas

  • Surgery

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Right hepatectomy for living donation : Role of remnant liver volume in predicting hepatic dysfunction and complications. / Facciuto, Marcelo; Contreras-Saldivar, Alan; Singh, Manoj K.; Rocca, Juan P.; Taouli, Bachir; Oyfe, Irina; Rudow, Dianne Lapointe; Gondolesi, Gabriel E.; Schiano, Thomas D.; Kim-Schluger, Leona; Schwartz, Myron E.; Miller, Charles M.; Florman, Sander.

In: Surgery (United States), Vol. 153, No. 5, 05.2013, p. 619-626.

Research output: Contribution to journalArticle

Facciuto, M, Contreras-Saldivar, A, Singh, MK, Rocca, JP, Taouli, B, Oyfe, I, Rudow, DL, Gondolesi, GE, Schiano, TD, Kim-Schluger, L, Schwartz, ME, Miller, CM & Florman, S 2013, 'Right hepatectomy for living donation: Role of remnant liver volume in predicting hepatic dysfunction and complications', Surgery (United States), vol. 153, no. 5, pp. 619-626. https://doi.org/10.1016/j.surg.2012.11.020
Facciuto, Marcelo ; Contreras-Saldivar, Alan ; Singh, Manoj K. ; Rocca, Juan P. ; Taouli, Bachir ; Oyfe, Irina ; Rudow, Dianne Lapointe ; Gondolesi, Gabriel E. ; Schiano, Thomas D. ; Kim-Schluger, Leona ; Schwartz, Myron E. ; Miller, Charles M. ; Florman, Sander. / Right hepatectomy for living donation : Role of remnant liver volume in predicting hepatic dysfunction and complications. In: Surgery (United States). 2013 ; Vol. 153, No. 5. pp. 619-626.
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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 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.",
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T1 - Right hepatectomy for living donation

T2 - Role of remnant liver volume in predicting hepatic dysfunction and complications

AU - Facciuto, Marcelo

AU - Contreras-Saldivar, Alan

AU - Singh, Manoj K.

AU - Rocca, Juan P.

AU - Taouli, Bachir

AU - Oyfe, Irina

AU - Rudow, Dianne Lapointe

AU - Gondolesi, Gabriel E.

AU - Schiano, Thomas D.

AU - Kim-Schluger, Leona

AU - Schwartz, Myron E.

AU - Miller, Charles M.

AU - Florman, Sander

PY - 2013/5

Y1 - 2013/5

N2 - 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.

AB - 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.

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