Right hepatectomy for living donation: Role of remnant liver volume in predicting hepatic dysfunction and complications

Background: Extensive attention has been placed on remnant liver volume (RLV) above other factors to ensure donor safety. Methods: We performed a retrospective review of 137 right hepatectomies in live donors between June 1999 and November 2010. Results: Median right lobe volume was 1,029 cm³, which correlated with its actual weight (r = 0.63, P <.01); median RLV was 548 cm³. Of the donors, 32 (24%) developed postoperative hepatic dysfunction (bilirubin >3 mg/dL or prothrombin time >18 s on postoperative day 4). RLV did not predict postoperative hepatic dysfunction (P =.9), but it was associated with peak international normalized ratio (INR) (P =.04). Donor age and male gender were predictors of increased bilirubin at postoperative day 4 (age, P =.03; gender, P =.02). Of the donors, 45 (33%) experienced complications, and 24 donors had RLVs <30%; 42% experienced complications compared to 31% of donors whose RLVs were greater than 30% (P =.3). Cell-saver utilization and aspartate-aminotransferase (AST) levels (OR = 3) were associated with complications. Volumetric assessment can predict RLV accurately. Conclusion: Although no demonstrable association between RLV <30% and complications was found, an RLV of 30% should remain the threshold for donor safety. Age and gender should be balanced in donors with a near threshold RLV of 30%. Surgical complexity, suggested by the need for intraoperative autoinfusion of blood and postoperative levels of AST, remained the independent predictor of complications.