Extent of right hepatectomy determines postoperative donor albumin and bilirubin changes: new insights


Roman Schumann, MD, Department of Anesthesia, Tufts-New England Medical Center, 750 Washington Street, T-NEMC # 298, Boston, MA 02111, USA
Tel: +1 617 636 6044
Fax: +1 617 636 8384
e-mail: Rschumann@tufts-nemc.org


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/m2) 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.