Postoperative impact of intraoperative biochemical changes at the completion of parenchymal division in living-donor liver transplantation.
OBJECTIVE
Biochemical abnormalities after living-donor hepatectomy are attributed to the loss of liver volume and steatosis or fibrosis. In this study, we evaluated the intraoperative biochemical changes caused by the separation of the hepatic lobes before removal and the impact of those changes on postoperative biochemical abnormalities in patients who underwent adult-to-adult living-donor liver transplantation (LDLT).


METHODS
The extent and postoperative impact of the biochemical changes that occur during hepatic parenchymal transection in adult-to- adult LDLT were studied in 38 patients who underwent that procedure (14 men and 24 women; mean age, 39.6 years; age range, 19.5-58.9 years). Preoperative, intraoperative, and postoperative biochemical values for the first 8 postoperative days were compared.


RESULTS
The mean total hepatic volume was 1703.0 mL, the mean weight of the resected mass was 887.0 g (52.6%), and the mean weight of the residual mass was 816.0 g (47.4%). The mean total bilirubin, aspartate amino transferase (AST), and amino alanine transferase (ALT) values were 8.6 U/L, 21.4 U/L, and 27.6 U/L, respectively, before surgery, compared with 27.4 U/L (an increase of 3.2 times), 257.9.2 U/L (an increase of 12.0 times), and 224.64 U/L (an increase of 8.1 times), respectively, after separation of the hepatic lobes. Patients (n = 21) with an intraoperative ALT value of >or= 200 had a significantly higher peak postoperative ALT (P = .001) than did those (n = 17) with an ALT value of < 200.


CONCLUSIONS
A significant increase in hepatic biochemical parameters occurs at the completion of hepatic parenchymal transection and before the removal of the right hepatic lobe from the donor. This has an impact on postoperative peak enzyme levels in the donor.
Jain
Ashok
A
Department of Surgery, Division of Transplantation, University of Rochester Medical Center, Rochester, New York 14642, USA. ashok_jain@urmc.rochester.edu
Orloff
Mark
M
Abt
Peter
P
Kashyap
Randeep
R
Mantry
Parvez
P
Bozorgzadeh
Adel
A
D000328:Adult; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000033:anatomy & histology; D016031:Liver Transplantation / Q000379:methods* / Q000502:physiology; D019520:Living Donors; D008297:Male; D016343:Monitoring, Intraoperative; D011184:Postoperative Period; D020858:Tissue and Organ Harvesting / Q000379:methods*
D015415:Biomarkers; D001663:Bilirubin