title: Effect of intermittent hepatic inflow occlusion with the Pringle maneuver during donor hepatectomy in adult living donor liver transplantation with right hemiliver grafts: a prospective, randomized controlled study.
abstract: To evaluate the effects of intermittent hepatic inflow occlusion (IHIO) during donor hepatectomy for living donor liver transplantation (LDLT) in recipients and donors, we performed a single-center, open-label, prospective, parallel, randomized controlled study. Adult donor-recipient pairs undergoing LDLT with right hemiliver grafts were randomized into IHIO and control groups (1:1). In the IHIO group, IHIO was performed during donor hepatectomy. The primary endpoint was the peak serum alanine aminotransferase (ALT) concentration in the recipients within 5 days after the operation. Blood samples for measurements of interleukin-6 (IL-6), IL-8, tumor necrosis factor α (TNF-α), and hepatocyte growth factor (HGF) were taken from the donors and the recipients during the operation and postoperatively. Biopsy samples for measurements of caspase-3 and malondialdehyde (MDA) were taken from the donors and the recipients. In all, 50 donor-recipient pairs (ie, 25 pairs in each group) completed this study. The mean peak serum ALT levels within 5 days after the operation did not differ in the recipients between the 2 groups (P = 0.32) but were higher in the donors of the IHIO group (P = 0.002). There were no differences in the prothrombin times or total bilirubin levels in the recipients or donors between the 2 groups. The amount of blood loss during donor hepatectomy was significantly lower in the IHIO group versus the control group (P = 0.02). The mean hospital stay for donors was 19.3 ± 7.2 days in the control group and 15.8 ± 4.6 days in the IHIO group (P = 0.046). There were no in-hospital deaths within 1 month and no cases of primary nonfunction or initially poor function in the 2 groups. The concentrations of IL-6, IL-8, TNF-α, and HGF did not differ between the 2 groups, nor did the concentrations of caspase-3 and MDA. In conclusion, although we found differences in postoperative peak serum ALT levels in donors, donor hepatectomy with IHIO for LDLT using a right hemiliver graft with a graft-to-recipient body weight ratio > 0.9% and <30% steatosis can be a tolerable procedure for donors and recipients.
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Jae Berm
authors.initials: JB
authors.lastname: Park
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Joh
authors.forename: Sung-Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Choon-Hyuck David
authors.initials: CH
authors.lastname: Kwon
authors.forename: Jae Min
authors.initials: JM
authors.lastname: Chun
authors.forename: Jong Man
authors.initials: JM
authors.lastname: Kim
authors.forename: Ju Ik
authors.initials: JI
authors.lastname: Moon
authors.forename: Suk-Koo
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001706:Biopsy; D053148:Caspase 3 / Q000378:metabolism; D016207:Cytokines / Q000097:blood; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D017228:Hepatocyte Growth Factor / Q000097:blood; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000378:metabolism / Q000601:surgery*; D008102:Liver Circulation / Q000502:physiology*; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008315:Malondialdehyde / Q000378:metabolism; D008875:Middle Aged; D011446:Prospective Studies; D014180:Transplantation; D016896:Treatment Outcome
chemical_list: D016207:Cytokines; D008315:Malondialdehyde; D017228:Hepatocyte Growth Factor; D000410:Alanine Transaminase; D053148:Caspase 3