Extent of right hepatectomy determines postoperative donor albumin and bilirubin changes: new insights.
BACKGROUND
Changes in donor plasma albumin (Alb) and bilirubin (Tbili) are common following right hepatectomy for liver transplantation. We conducted a retrospective study to determine whether the size of the liver resection and the estimated blood loss (EBL) impact these laboratory values in the first week (early) and third week (late) postoperatively.


METHODS
Demographics and peri-operative data of 34 donors undergoing right hepatectomy were analysed by Spearman's correlation (data in means+/-SD, P<0.05=statistically significant). Re-admissions for pleural effusions were tracked.


RESULTS
Donors were 26-56 (43.3+/-9.1) years old, body mass index (kg/m(2)) was 27.7+/-4.2, liver resected (%) was 58+/-7 and EBL (mL) was 1505+/-927. A larger hepatectomy correlated with lower Alb at 3 weeks (P=0.03) and also with a higher early (P=0.025) and late Tbili (P=0.037). Larger blood loss determined low Alb in the first week (P=0.013), still noticeable 3 weeks postoperatively (P=0.047). Re-admissions for pleural effusion were not associated with the size of the liver resection or postoperative Alb changes.


CONCLUSIONS
A remaining liver size-dependent reduced synthetic hepatic function may explain the persistent low Alb that becomes apparent at end of the preoperative Albs half-life. A size-related diminished metabolic liver capacity results in early and late elevated Tbili. Prospective studies are needed to better understand the impact of resection size on hepatic physiology, donor care and clinical outcomes.
Schumann
Roman
R
Department of Anesthesia, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA. Rschumann@tufts-nemc.org
Bonney
Iwona
I
McDevitt
Lisa M
LM
Cooper
Jeffrey T
JT
Cepeda
M Soledad
MS
D000328:Adult; D001663:Bilirubin / Q000097:blood*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000097:blood*; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*; D014019:Tissue Donors
D012709:Serum Albumin; D001663:Bilirubin