Factors Predicting Prolongation of the Prothrombin Time after Liver Donor Hepatectomy / 대한마취과학회지

ABSTRACT

BACKGROUND: The increasing shortage of liver donors has resulted in exponential growth of living donor liver transplantation (LDLT). There are obvious concerns about the increased risk to the donors. There has been study on the impact of donation as a function of the degree of resection. However, the effect of inhaled anesthetics combined with the degree of parenchymal loss on the liver function has not been quantified. We analyzed the prothrombin time (PT), as hepatic synthetic function, after donor hepatectomy (DH) with the recipient undergoing general anesthesia with different types of inhaled anesthetics. METHODS: One-hundred thirty-four patients who underwent DH were enrolled. The patients were randomly divided into four groups enflurane (group E), isoflurane (group I), sevoflurane (group S), and desflurane (group D). Anesthesia was performed according to institutional standards. The PT was measured for 7 days before and daily after DH (POD). Total liver volume and resected liver volume were measured and fraction of the graft volume was calculated. RESULTS: The PT peaked on POD 1 in all groups. A significantly lower PT was observed in group D compared to the other groups until POD 3. The fraction of the graft volume showed significant correlation with the PT change. PT abnormalities were affected by the preoperative PT, the graft fraction and inhaled anesthetics. CONCLUSIONS: Desflurane induced lesser elevation of the PT than did the other inhaled anesthetics until POD 3. The preoperative PT, the graft fraction and the inhaled anesthetics may be key factors for inducing postoperative PT abnormalities.