Living donor hepatectomy (LDH)--comparative study between two different anesthetic techniques

Living donor hepatectomy (LDH) is now widely used to meet the need for liver grafts due to the shortage of cadaveric livers. Donor safety and perioperative anesthetic management are our major concern. The aim of our study was to compare two anesthetic techniques for management of living donor hepatectomy.

After ethical committee approval and informed written consent, 20 donors ASA I physical status undergoing hepatectomy for living-relative liver transplant were allocated randomly to one of two groups. Group A where anesthesia was induced with fentanyl 2 microg/kg and propofol 2-3 mg/kg(-1), and maintained with isoflurane 0.8-1.2% and fentanyl infusion 1-2mcg/kg(-1)/h(-1). In group B anesthesia was induced with sufentanyl 0.2mcg/kg(-1), and propofol 2-3mg/kg(-1), and maintained with propofol infusion 6-12 mg/kg(-1)/h(-1), and sufentanyl infusion 0.2-0.4mcg/kg(-1)/h(-1). Atracurium was the muscle relaxant for intubation and maintenance in both groups.

There were no perioperative mortality in both groups, no significant statistical differences between both groups as regard demographic data, duration of surgery, duration of anesthesia, hospital stay, intraoperative hemodynamics, blood loss, liver function tests (PT, AST, & ALT) measured in the first, third, and seventh days postoperative.

In conclusion, our study demonstrated that both anesthetic techniques were well tolerated for living donor hepatectomy, with no blood transfusion required, with short and safe discharge from PACU and short hospital stay, but with significant laboratory changes reflecting transient impairment in metabolic liver function. These procedures have proven useful as an important alternative to the cadaveric liver transplantation. Both techniques can be used as fast tract technique for living donor hepatectomy.