Fluid management in living donor hepatectomy: Recent issues and perspectives

Abstract

The importance of the safety of healthy living liver donors is widely recognized during donor hepatectomy which is associated with blood loss, transfusion, and subsequent post-operative morbidity. Although the low central venous pressure (CVP) technique can still be effective, it may not be advantageous concerning the safety of healthy donors undergoing hepatectomy. Emerging evidence suggests that stroke volume variation (SVV), a simple and useful index for fluid responsiveness and preload status in various clinical situations, can be applied as a guide for fluid management to reduce blood loss during living donor hepatectomy. Synthetic colloid solutions are also associated with serious adverse events such as the use of renal replacement therapy and transfusion in critically ill or septic patients. However, it is uncertain whether the intra-operative use of colloid solution is associated with similarly adverse effects in patients undergoing living donor hepatectomy. In this review article we discuss the recent issues regarding the low CVP technique and the high SVV method, i.e., maintaining 10%-20% of SVV, for fluid management in order to reduce blood loss during living donor hepatectomy. In addition, we briefly discuss the effects of intra-operative colloid or crystalloid administration for surgical rather than septic or critically ill patients.

Keywords: Central venous pressure; Donor hepatectomy; Fluid; Stroke volume variation; Synthetic colloid.

Figures

Figure 1

Evolution of liver transplantation at Asan Medical Center, University of Ulsan College of Medicine. From February 1997 to April 2013, 3000 ALDLTs were performed without donor mortality. As of 2010, the annual number of ALDLTs exceeded 300 and with increased performance of ABO-incompatible ALDLT. ALDLT: Adult living donor liver transplantation; DDLT: Deceased donor liver transplantation; LDLT: Living donor liver transplantation; RL: Right-lobe; LL: Left-lobe; LT: Liver transplantation; OLT: Orthotopic liver transplantation. Jan: January; Feb: February; Mar: March; Apr: April; Jul: July; Aug: August; Sep: September; Oct: October; Nov: November; Dec: December. Reprinted with permission[4].

Figure 2

Effect of stroke volume variation-directed fluid management on blood loss during living donor right hepatectomy. The control group (

Figure 3

Proposed algorithm of stroke volume variation-guided fluid management during living donor hepatectomy. SVV: Stroke volume variation. Modified with permission[15].