Postoperative management for donor safety in living related donor liver transplantation.
OBJECTIVE
Living related donor liver transplantation must hold on in absolute donor safety. Nevertheless, the risks to the donors are increased because of the use of right lobe for size mismatch. Therefore the intensive management for donor operation can hardly be overestimated. In this study, we investigated the utility of prostaglandin E1, methylprednisolone and C-tube in the postoperative management for donor operation based on our understanding of the mechanisms of liver injury after massive hepatectomy.


METHODS
Outcome of the thirteen donors, whose right lobe was removed (right lobe group: 7 cases) or the left lobe only (3 cases) and left lobe plus caudate lobe (3 cases) (left lobe group: 6 cases) from 1999 March to 2000 August, for living related liver transplantation were evaluated. Indication for right lobe living related liver transplantation was basically defined as an estimated left lobe volume/recipient body weight ratio (GVBW ratio) of < 0.8% (range: 0.65-1.4, right lobe group: 1.05 +/- 0.18, left lobe group: 0.89 +/- 0.16).


RESULTS
The donors recovered from the operation without the differentiation between right and left lobe group. There were no significant differences in the operative time, the operative hemorrhage, the hospital stays and the postoperative liver function in the two groups. They had no bile leakage and no serious complications. We experienced the left lobe donor who suffered from a cholangitis without any infection and he recovered by the administration of prostaglandin E1 and steroid. They improved bile secretion and bilirubinemia. Eleven recipients (84.6%) were successfully treated. The two causes of death were the sepsis (right lobe) and brain hemorrhage (left lobe).


CONCLUSIONS
The current series of right lobe donation was able to show successful results as well as left lobe donation by the postoperative management with steroid, prostaglandin E1 and C-tube drainage based on our understanding of liver injury after massive hepatectomy in the adult-to-adult living donor liver transplantation.
Sato
Yoshinobu
Y
First Department of Surgery, School of Medicine, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8510, Japan.
Kurosaki
Isao
I
Yamamoto
Satoshi
S
Nakatsuka
Hideki
H
Oya
Hiroshi
H
Shirai
Yoshio
Y
Tanaka
Koichi
K
Hatakeyama
Katsuyoshi
K
D000328:Adult; D000368:Aged; D000527:Alprostadil / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D004322:Drainage; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007440:Intubation; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*; D017093:Liver Failure / Q000000981:diagnostic imaging / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011182:Postoperative Care; D011183:Postoperative Complications; D011859:Radiography; D012449:Safety
D000893:Anti-Inflammatory Agents; D010975:Platelet Aggregation Inhibitors; D000527:Alprostadil; D008775:Methylprednisolone