Intraoperative factors associated with delayed recovery of liver function after hepatectomy: analysis of 1969 living donors

Choi, Seong-Soo; Cho, S.-S.; Ha, Tae Yong; Hwang, Shin; Lee, S.-G.; Kim, Young‐Kug

doi:10.1111/aas.12630

Cited by 10 publications

(9 citation statements)

References 44 publications

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“…However, no studies have directly shown that age is a risk factor for PHLF in donor hepatectomy. Instead, Choi et al reported that liver regeneration was delayed in young donors . The present study also supported this finding; “forced entry” of age in the multivariate regression analysis failed to include age as a significant predictive factor for PHLF.…”

Section: Discussionsupporting

confidence: 78%

Low Preoperative Platelet Count Predicts Risk of Subclinical Posthepatectomy Liver Failure in Right Lobe Donors for Liver Transplantation

et al. 2018

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Living donor right hepatectomy (LDRH) is a common procedure in adult-to-adult living donor liver transplantation, but it is associated with a higher risk of posthepatectomy liver failure (PHLF) compared with left hepatectomy because of a smaller remnant. We identified risk factors for PHLF and other complications in LDRH, verified the appropriateness of the criteria, and explored the possibility of adjusting the minimum remnant liver volume (RLV) based on individual risk. Between October 2005 and November 2017, 254 donors undergoing LDRH at Kyoto University Hospital were enrolled. Clinical data were collected retrospectively. All complications were graded according to the Clavien-Dindo classification. No donors had grade 4 or 5 complications or clinically significant grade B or C PHLF. Grade A PHLF occurred in 30 donors (11.8%). Male sex (P = 0.01), lower preoperative platelet count (PLT; P = 0.01), higher prothrombin time-international normalized ratio (P = 0.03), higher total bilirubin (P = 0.01), smaller RLV (P = 0.03), and greater blood loss (P = 0.04) were associated with increased risk of PHLF in the univariate analysis, whereas PLT, RLV, and blood loss remained significant in the multivariate analysis. Grade 2 or 3 complications were observed in 32 (12.6%) donors. Higher body mass index (BMI; P = 0.002) and larger blood loss (P = 0.02) were identified as risk factors for complications (Clavien-Dindo grade ≥ 2) in univariate analysis. Only BMI remained significant in the multivariate analysis. In conclusion, LDRH is performed safely with acceptable morbidity under the current criteria. Minimum RLV may be marginally adjusted by PLT and reducing intraoperative blood loss minimizes PHLF risk. Liver Transplantation 00 000-000 2018 AASLD.

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Section: Discussionsupporting

confidence: 78%

Low Preoperative Platelet Count Predicts Risk of Subclinical Posthepatectomy Liver Failure in Right Lobe Donors for Liver Transplantation

et al. 2018

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“…Anesthesia management for living donor hepatectomy was performed in accordance with our institutional standards. 16 , 17 Briefly, anesthesia was induced with 5 mg/kg thiopental sodium and 1 to 2 μg/kg fentanyl, and 0.6 mg/kg rocuronium was used to facilitate tracheal intubation. Anesthesia was maintained at 1 to 2% sevoflurane in addition to the intermittent bolus administration of fentanyl and rocuronium.…”

Section: Methodsmentioning

confidence: 99%

High Stroke Volume Variation Method by Mannitol Administration Can Decrease Blood Loss During Donor Hepatectomy

Seo

Jun

et al. 2016

Medicine

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Optimal fluid management to reduce blood loss during donor hepatectomy is important for maximizing donor safety. Mannitol can induce osmotic diuresis, helping prevent increased intravascular volume status. We therefore evaluated the effect of high stroke volume variation (SVV) method by mannitol administration and fluid restriction on blood loss during donor hepatectomy.In this prospective study, 64 donors scheduled for donor right hepatectomy were included and allocated into 2 groups. In group A, the SVV value of each patient was maintained at 10% to 20% during hepatic resection with 0.5 g/kg mannitol administration and fluid restriction at a rate of 2 to 4 mL/kg/h. In group B, the SVV value was maintained at <10% by fluid administration at a rate of 6 to 10 mL/kg/h without diuretic administration during surgery. Intraoperative blood loss was estimated by the loss of red cell mass. Surgeon satisfaction scores and postoperative outcomes, including acute kidney injury, abnormal chest radiographic findings, and hospital stay duration, were also assessed.SVV during hepatectomy was significantly higher in group A than in group B (11.0 ± 1.7 vs 6.5 ± 1.1, P < 0.001). The red cell mass loss was significantly lower in group A than in group B (145.4 ± 107.6 vs 307.9 ± 110.7 mL, P < 0.001). Surgeon satisfaction scores were higher in group A than in group B (2.8 ± 0.5 vs 2.0 ± 0.6, P < 0.001). The incidence of acute kidney injury, abnormal chest radiographic findings, and duration of hospital stay did not significantly differ between the 2 groups.Maintenance of high SVV by mannitol administration is effective and safe for reducing blood loss during donor hepatectomy.

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“…The time for patients with general anesthesia to recover from anesthesia mainly depends on the metabolic rate of analgesic drugs. [ 23 ] In recent years, the comprehensive evaluation of patients before surgery and the continuous development of anesthetic drugs and monitoring technology have reduced the occurrence of anesthesia DR. [ 24 ] The rate gradually declines, and most patients can wake up quickly after surgery, but the phenomenon of delayed wake-up still occurs, which brings a huge challenge to medical staff related to anesthesia. [ 25 ] The basic patient factors include age, sex, genetic factors, and preoperative combined underlying diseases.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of delayed recovery from general anesthesia in patients undergoing radical biliary surgery

Zhang¹,

Pan²,

Tan³

et al. 2021

Medicine

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Delayed recovery (DR) is very commonly seen in the patients undergoing laparoscopic radical biliary surgery, we aimed to investigate the potential risk factors of DR in the patients undergoing radical biliary surgery, to provide evidences into the management of DR. Patients who underwent radical biliary surgery from January 1, 2018 to August 31, 2020 were identified. The clinical characteristics and treatment details of DR and no-DR patients were compared and analyzed. Multivariable logistic regression analyses were conducted to identify the potential influencing factors for DR in patients with laparoscopic radical biliary surgery. We included a total of 168 patients with laparoscopic radical biliary surgery, the incidence of postoperative DR was 25%. There were significant differences on the duration of surgery, duration of anesthesia, and use of intraoperative combined sevoflurane inhalation (all P < .05), and there were not significant differences on American Society of Anesthesiologists, New York Heart Association, tumor-lymph node- metastasis, and estimated blood loss between DR group and control group (all P > .05). Multivariable logistic regression analyses indicated that age ≥70 years (odd ratio [OR] 1.454, 95% confidence interval [CI] 1.146–1.904), body mass index ≥25 kg/m 2 (OR 1.303, 95% CI 1.102–1.912), alcohol drinking (OR 2.041, 95% CI 1.336–3.085), smoking (OR 1.128, 95% CI 1.007–2.261), duration of surgery ≥220 minutes (OR 1.239, 95% CI 1.039–1.735), duration of anesthesia ≥230 minutes (OR 1.223, 95% CI 1.013–1.926), intraoperative combined sevoflurane inhalation (OR 1.207, 95% CI 1.008–1.764) were the independent risk factors for DR in patients with radical biliary surgery (all P < .05). It is clinically necessary to take early countermeasures against various risk factors to reduce the occurrence of DR, and to improve the prognosis of patients.

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Intraoperative factors associated with delayed recovery of liver function after hepatectomy: analysis of 1969 living donors

Cited by 10 publications

References 44 publications

Low Preoperative Platelet Count Predicts Risk of Subclinical Posthepatectomy Liver Failure in Right Lobe Donors for Liver Transplantation

Low Preoperative Platelet Count Predicts Risk of Subclinical Posthepatectomy Liver Failure in Right Lobe Donors for Liver Transplantation

High Stroke Volume Variation Method by Mannitol Administration Can Decrease Blood Loss During Donor Hepatectomy

Risk factors of delayed recovery from general anesthesia in patients undergoing radical biliary surgery

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