Effects of Sugammadex on the Coagulation Profile of Living Liver Donors Undergoing Hepatectomy: A Case-Control Study

Background: The most important concern regarding living donor liver transplantation is the safety of living liver donors, of which anesthesia management is an important part. Sugammadex, which has recently been used frequently for the reversal of neuromuscular blockade, is known to cause adverse effects on the coagulation profile. This study seeks to assess the impact of neostigmine and sugammadex on coagulation parameters in living liver donors following hepatectomy. Methods: We compared the demographic, clinical, and coagulation parameters of 209 living liver donors who received sugammadex (2 mg/kg) for neuromuscular blockade reversal during donor hepatectomy procedures from January 2018 to July 2022, with 209 patients who received neostigmine (50 g/kg) for the same purpose during the same timeframe. We compared the following parameters: age, gender, prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), hemoglobin (Hb), platelet count, ICU stay, hospital stay, and relaparotomy for bleeding and other causes. Results: Demographic data and preoperative biochemical values were similar in both groups. PT (p = 0.004) and aPTT (p < 0.001) values were significantly longer in the postoperative period in both groups; the difference between preoperative and postoperative PT (p = 0.009) and aPTT (p < 0.001) was significantly higher in the sugammadex group. However, neither group showed any elongation beyond the reference range. The sugammadex group had an elevated postoperative platelet count (p = 0.040). The duration of patients' stay in the ICU was significantly shorter in the sugammadex group (p < 0.001). Conclusion: The prolonged aPTT and PT associated with sugammadex did not lead to any postoperative bleeding complications. The sugammadex group significantly reduced the duration of ICU stays, while the hospital stays remained comparable. Further multicentric prospective randomized studies should support our study's findings, which demonstrate the safe use of low-dose sugammadex.