Outcome Comparison of Right Hepatectomy among Living Liver Donation and Hepatic Patients with or Without Cirrhosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Shengke , LI Chuan , MI Kai ,  WEN Tianfu , YAN Lnan , LI Bo , YANG Jiayin , WANG Wentao , XU Mingqing

Division of Liver Transplantation Center， Department of Liver Surgery， West China Hospital of Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

WEN Tianfu, Email: cctianfuwen@sohu.com

Keywords：

Cirrhosis; Living donor liver transplantation; Right hepatectomy

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Objective 　To approach whether the postoperative recovery processes of the living donors and hepatic
patients after right hepatectomy is similar.
Methods 　The clinical data of consecutive cases from 2009 to 2010 in our liver transplantation center was retrospectively analyzed， including 40 cases who donated the right lobe without the middle
hepatic vein （living donor liver transpalntation-donor group， abbreviated as LDLT-D group） and 80 hepatic patients for
right hepatectomy， in which 40 cases were hepatic patients without cirrhosis （liver disease-noncirrhosis group， abbreviated
as LD-NC group） and 40 cases were hepatic patients with cirrhosis （liver disease-with cirrhosis group， abbreviated as
LD-WC group）. Preoperative liver function and general clinical data， intraoperative blood loss and transfusion， postoper-
ative liver function， and complications were statistically analyzed in this study.
Results 　The preoperative parameters of three groups were comparable. LDLT-D group experienced more intraoperative bleeding than LD-NC group 〔（765±411） mL vs. （584±242） mL， P=0.008〕， and was similar to LD-WC group 〔（666±224） mL， P=0.136〕. However， the average amount of blood transfusion products was similar among the 3 groups （P=0.108）. The levels of total bilirubin and INR of LDLT-D group were higher than LD-NC group and LD-WC group on the first and third day after operation （P＜0.05）. The levels of ALT and AST of LD-WC group were higher than LDLT-D group and LD-NC group （P＜0.05）. The overall postoperative surgical morbidity incidence of LDLT-D group， LD-NC group， and LD-WC group were 30.0%（12/40）， 27.5% （11/40）， and 37.5% （15/40） respectively， and were not statistically significant （P=0.606）. However， the ClavienⅢcomplication rate of LD-WC group was higher than LDLT-D group and LD-NC group 〔27.5% （11/40） vs. 7.5%（3/40） and 10.0% （4/40）， P=0.024〕.
Conclusions 　Liver function of living donors is injured more seriously during the early postoperative period. The total complication rates after right hepatectomy are similar among the living liver donation and hepatic patients with or without cirrhosis. However， the serious complication rate of cirrhotic liver recipients is higher than living donors and patients without cirrhosis.

Citation： YANG Shengke,LI Chuan,MI Kai,WEN Tianfu,YAN Lnan,LI Bo,YANG Jiayin,WANG Wentao,XU Mingqing,.. Outcome Comparison of Right Hepatectomy among Living Liver Donation and Hepatic Patients with or Without Cirrhosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(7): 756-761. doi: Copy

1.	Gali B， Findlay JY， Plevak DJ， et al. Right hepatectomy for livingliver donation vs. right hepatectomy for disease：intraoperative and immediate postoperative comparison[J]. Arch Surg， 2007， 142(5)： 467-472.
2.	Lee SG， Hwang S， Kim KH， et al. Toward 300 liver transplants a year[J]. Surg Today， 2009， 39(5)： 367-373.
3.	文天夫，严律南，李波，等. 活体右半肝供体的安全性[J]. 中华外科杂志， 2006， 44(3)：149-152.
4.	Midorikawa Y， Kubota K， Takayama T， et al. A comparative study of postoperative complications after hepatectomy in patients with and without chronic liver disease[J]. Surgery， 1999， 126(3)： 484-491.
5.	Shackleton CR， Vierling JM， Nissen N， et al. Morbidity in live liver donors：standards-based adverse event reporting further refined[J]. Arch Surg， 2005， 140(9)： 888-896.
6.	Beavers KL， Sandler RS， Shrestha R. Donor morbidity associatedwith right lobectomy for living donor liver transplantation to adult recipients：a systematic review[J]. Liver Transpl， 2002， 8(2)： 110-117.
7.	Hashikura Y， Ichida T， Umeshita K， et al. Donor complications associated with living donor liver transplantation in Japan[J]. Transplantation， 2009， 88(1)： 110-114.
8.	Barr ML， Belghiti J， Vilamil FG， et al. A report of the Vancouver Forum on the care of the live organ donor： lung， liver， pancreas， and intestine data and medical guidelines[J]. Transplantation， 2006， 81(10)：1373-1385.
9.	Ran S， Wen TF， Li B， et al. Risks faced by donors of right lobe for living donor liver transplantation[J]. Hepatobiliary Pancreat Dis Int， 2009， 8(6)：581-585.
10.	Wei AC， Tung-Ping Poon R， Fan ST， et al. Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma[J]. Br J Surg， 2003， 90(1)： 33-41.
11.	Dindo D， Demartines N， Clavien PA. Classification of surgicalcomplications： a new proposal with evaluation in a cohort of 6 336 patients and results of a survey[J]. Ann Surg， 2004， 240(2)： 205-213.
12.	Clavien PA， Barkun J， de Oliver ML， et al. The Clavien-Dindo classification of surgical complications： five-year experience[J]. Ann Surg， 2009， 250(2)： 187-196.
13.	Middleton PF， Duffied M， Lynch SV， et al. Living donor liver transplantation—adult donor outcomes：a systematic review[J]. Liver Transpl， 2006， 12(1)： 24-30.
14.	Marsh JW， Gray E， Ness R， et al. Complications of right lobe living donor liver transplantation[J]. J Hepatol， 2009， 51(4)：715-724.
15.	Chiappa A， Zbar AP， Audisio RA， et al. Factors affecting survivaland long-term outcome in the cirrhotic patient undergoing hepatic resection for hepatocellular carcinoma[J]. Eur J Surg Oncol， 2000， 26(4)： 387-392.
16.	Farges O， Malassagne B， Flejou JF， et al. Risk of major liver resection in patients with underlying chronic liver disease： a reappraisal[J]. Ann Surg， 1999， 229(2)： 210-215.
17.	Nagasue N， Ono T， Yamanoi A， et al. Prognostic factors and survival after hepatic resection for hepatocellular carcinoma withoutcirrhosis[J]. Br J Surg， 2001， 88(4)： 515-522.
18.	Nagasue N， Yukaya H， Ogawa Y， et al. Portal pressure followingpartial to extensive hepatic resection in patients with and without cirrhosis of the liver[J]. Ann Chir Gynaecol， 1983， 72(1)： 18-22.
19.	Fan ST， Lo CM， Liu CL， et al. Safety of donors in live donor liver transplantation using right lobe grafts[J]. Arch Surg， 2000， 135(3)： 336-340.
20.	Lai PB， Chui PT， Leow CK， et al. Correlation between blood loss and inferior vena caval pressure during liver resection[J]. Br J Surg， 1998， 85(8)： 1158.
21.	Figueras J， Llado L， Ruiz D， et al. Complete versus selective portal triad clamping for minor liver resections： a prospective randomized trial[J]. Ann Surg， 2005， 241(4)： 582-590.
22.	Kim YI， Ishii T， Aramaki M， et al. The pringle maneuver inducesonly partial ischemia of the liver[J]. Hepatogastroenterology， 1995， 42(2)：169-171.
23.	Mullin EJ， Metcalfe MS， Maddern GJ. How much liver resection is too much?[J]. Am J Surg， 2005， 190(1)： 87-97.
24.	Sugiyama Y， Ishizaki Y， Imamura H， et al. Effects of intermittent Pringle’s manoeuvre on cirrhotic compared with normal liver[J]. Br J Surg， 2010， 97(7)： 1062-1069.

1. Gali B， Findlay JY， Plevak DJ， et al. Right hepatectomy for livingliver donation vs. right hepatectomy for disease：intraoperative and immediate postoperative comparison[J]. Arch Surg， 2007， 142(5)： 467-472.
2. Lee SG， Hwang S， Kim KH， et al. Toward 300 liver transplants a year[J]. Surg Today， 2009， 39(5)： 367-373.
3. 文天夫，严律南，李波，等. 活体右半肝供体的安全性[J]. 中华外科杂志， 2006， 44(3)：149-152.
4. Midorikawa Y， Kubota K， Takayama T， et al. A comparative study of postoperative complications after hepatectomy in patients with and without chronic liver disease[J]. Surgery， 1999， 126(3)： 484-491.
5. Shackleton CR， Vierling JM， Nissen N， et al. Morbidity in live liver donors：standards-based adverse event reporting further refined[J]. Arch Surg， 2005， 140(9)： 888-896.
6. Beavers KL， Sandler RS， Shrestha R. Donor morbidity associatedwith right lobectomy for living donor liver transplantation to adult recipients：a systematic review[J]. Liver Transpl， 2002， 8(2)： 110-117.
7. Hashikura Y， Ichida T， Umeshita K， et al. Donor complications associated with living donor liver transplantation in Japan[J]. Transplantation， 2009， 88(1)： 110-114.
8. Barr ML， Belghiti J， Vilamil FG， et al. A report of the Vancouver Forum on the care of the live organ donor： lung， liver， pancreas， and intestine data and medical guidelines[J]. Transplantation， 2006， 81(10)：1373-1385.
9. Ran S， Wen TF， Li B， et al. Risks faced by donors of right lobe for living donor liver transplantation[J]. Hepatobiliary Pancreat Dis Int， 2009， 8(6)：581-585.
10. Wei AC， Tung-Ping Poon R， Fan ST， et al. Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma[J]. Br J Surg， 2003， 90(1)： 33-41.
11. Dindo D， Demartines N， Clavien PA. Classification of surgicalcomplications： a new proposal with evaluation in a cohort of 6 336 patients and results of a survey[J]. Ann Surg， 2004， 240(2)： 205-213.
12. Clavien PA， Barkun J， de Oliver ML， et al. The Clavien-Dindo classification of surgical complications： five-year experience[J]. Ann Surg， 2009， 250(2)： 187-196.
13. Middleton PF， Duffied M， Lynch SV， et al. Living donor liver transplantation—adult donor outcomes：a systematic review[J]. Liver Transpl， 2006， 12(1)： 24-30.
14. Marsh JW， Gray E， Ness R， et al. Complications of right lobe living donor liver transplantation[J]. J Hepatol， 2009， 51(4)：715-724.
15. Chiappa A， Zbar AP， Audisio RA， et al. Factors affecting survivaland long-term outcome in the cirrhotic patient undergoing hepatic resection for hepatocellular carcinoma[J]. Eur J Surg Oncol， 2000， 26(4)： 387-392.
16. Farges O， Malassagne B， Flejou JF， et al. Risk of major liver resection in patients with underlying chronic liver disease： a reappraisal[J]. Ann Surg， 1999， 229(2)： 210-215.
17. Nagasue N， Ono T， Yamanoi A， et al. Prognostic factors and survival after hepatic resection for hepatocellular carcinoma withoutcirrhosis[J]. Br J Surg， 2001， 88(4)： 515-522.
18. Nagasue N， Yukaya H， Ogawa Y， et al. Portal pressure followingpartial to extensive hepatic resection in patients with and without cirrhosis of the liver[J]. Ann Chir Gynaecol， 1983， 72(1)： 18-22.
19. Fan ST， Lo CM， Liu CL， et al. Safety of donors in live donor liver transplantation using right lobe grafts[J]. Arch Surg， 2000， 135(3)： 336-340.
20. Lai PB， Chui PT， Leow CK， et al. Correlation between blood loss and inferior vena caval pressure during liver resection[J]. Br J Surg， 1998， 85(8)： 1158.
21. Figueras J， Llado L， Ruiz D， et al. Complete versus selective portal triad clamping for minor liver resections： a prospective randomized trial[J]. Ann Surg， 2005， 241(4)： 582-590.
22. Kim YI， Ishii T， Aramaki M， et al. The pringle maneuver inducesonly partial ischemia of the liver[J]. Hepatogastroenterology， 1995， 42(2)：169-171.
23. Mullin EJ， Metcalfe MS， Maddern GJ. How much liver resection is too much?[J]. Am J Surg， 2005， 190(1)： 87-97.
24. Sugiyama Y， Ishizaki Y， Imamura H， et al. Effects of intermittent Pringle’s manoeuvre on cirrhotic compared with normal liver[J]. Br J Surg， 2010， 97(7)： 1062-1069.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Outcome Comparison of Right Hepatectomy among Living Liver Donation and Hepatic Patients with or Without Cirrhosis

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