title: Right hepatectomy for living donation: role of remnant liver volume in predicting hepatic dysfunction and complications.
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 cm(3), which correlated with its actual weight (r = 0.63, P < .01); median RLV was 548 cm(3). 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.
  
  
  CONCLUSIONS
  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.
authors: Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY 10029, USA. marcelo.facciuto@mountsinai.org
authors: Marcelo
authors: M
authors: Facciuto
authors: Alan
authors: A
authors: Contreras-Saldivar
authors: Manoj K
authors: MK
authors: Singh
authors: Juan P
authors: JP
authors: Rocca
authors: Bachir
authors: B
authors: Taouli
authors: Irina
authors: I
authors: Oyfe
authors: Dianne
authors: D
authors: LaPointe Rudow
authors: Gabriel E
authors: GE
authors: Gondolesi
authors: Thomas D
authors: TD
authors: Schiano
authors: Leona
authors: L
authors: Kim-Schluger
authors: Myron E
authors: ME
authors: Schwartz
authors: Charles M
authors: CM
authors: Miller
authors: Sander
authors: S
authors: Florman
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D048550:Hepatic Insufficiency / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D016014:Linear Models; D016031:Liver Transplantation; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*