Factors associated with hyperbilirubinemia after living donor hepatectomy

Increased serum bilirubin levels are common after living-donor hepatectomy. Little information is available on the characteristics and clinical significance of serum bilirubin levels soon after donor hepatectomy.

Since September 2001, we performed 229 living donor hepatectomies for living-donor liver transplantations. The 128 men and 101 women had a mean age of 34.4±8.9 years (range, 19-66). Most donors were parents (n=110; 48%). We transplanted 110 right lobes, 46 left lobes, and 73 left lateral segments. Donors were divided into 2 groups: Group 1 consisted of 181 donors who showed total bilirubin levels of <3 mg/dL, and group 2, 48 donors with levels of ≥3 mg/dL on postoperative day 3. Preoperative total bilirubin level, ratio of preoperatively estimated remnant liver volume, surgical duration, gender, age, graft type, blood transfusions, and preoperative liver biopsy findings were evaluated as risk factors for hyperbilirubinemia.

The mean postoperative maximum total bilirubin level was 2.26±1.49 mg/dL (range, 0.36-9.9). Remnant liver volume<40%, preoperative bilirubin levels>1 mg/dL, right lobe donor hepatectomy, male donor, and abnormal liver biopsy findings were significant risk factors for postoperative hyperbilirubinemia (P=.015, P=.02, P<.01, P=.008, and P=.023 respectively). Also donor age>50 years showed a slight effect on hyperbilirubinemia (P=.052). Blood transfusions and surgical times were not significant factors.

Donor safety is paramount, requiring thorough donor evaluation. Extensive liver resection may result in transient functional impairment. Several factors are believed to play roles in the development of postoperative hyperbilirubinemia after living-donor hepatectomy.