Before-after study of a restricted fluid infusion strategy for management of donor hepatectomy for living-donor liver transplantation.

Purpose: Intraoperative fluid infusion strategy remains controversial. Many animal model studies have shown that restricted fluid infusion reduces blood loss, though reports on this topic in humans are rare. The purpose of this study was to determine the effects on volume of blood loss of a restricted fluid infusion strategy for hepatectomy in donors for living donor liver transplantation.

Methods: A before-after study design was used with prospective consecutive data collection. A total of 22 patients who underwent living-donor hepatectomy were enrolled. Eleven patients who were managed before the implementation of restricted-volume fluid administration comprised the standard-volume group, and 11 who were evaluated after the implementation of the restricted-volume infusion strategy comprised the restricted-volume group. In the standard-volume group, the donors were given 10 ml x kg(-1) x h(-1) of lactated Ringer's solution and additional plasma expander corresponding to blood loss. In the restricted-volume group, the donors received 5 ml x kg(-1) x h(-1) of lactated Ringer's solution until the resection of the hepatic graft, followed by 15 ml x kg(-1) x h(-1) of lactated Ringer's solution after the completion of resection until the end of the operation.

Results: Intraoperative blood loss was less in the restricted-volume group (445 +/- 193 ml) than in the standard-volume group (1331 +/- 602 ml; P < 0.01). Intraoperative fluid infusion was also less in the restricted-volume group (4130 +/- 563 ml) than in the standard-volume group (5634 +/- 1260 ml; P < 0.01). There were no differences in length of hospital stay or side effects between the two groups.

Conclusion: Our restricted-volume strategy reduced blood loss and had no adverse effects during living-donor hepatectomy.