CLINICAL STUDIES Extent of right hepatectomy determines postoperative donor albumin and bilirubin changes: new insights Roman Schumann 1 , Iwona Bonney 1 , Lisa M. McDevitt 2 , Jeffrey T. Cooper 3 and M. Soledad Cepeda 1 1 Department of Anesthesia, at Tufts-New EnglandMedical Center, Tufts University School of Medicine, Boston, MA, USA 2 Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA 3 Department of Surgery, Division of Transplant Surgery, at Tufts-New England Medical Center, Tufts University School of Medicine, Boston, MA, USA Keywords donor complications – liver function – liver resection – liver transplantation – pleural effusion – synthetic hepatic insufficiency Correspondence Roman Schumann, MD, Department of Anesthesia, Tufts-New England Medical Center, 750 Washington Street, T-NEMC # 298, Boston, MA 02111, USA Tel: 11 617 636 6044 Fax: 11 617 636 8384 e-mail: Rschumann@tufts-nemc.org Received 8 April 2007 accepted 19 August 2007 DOI:10.1111/j.1478-3231.2007.01594.x Abstract Background: Changes in donor plasma albumin (Alb) and bilirubin (Tbili) are common following right hepatectomy for liver transplantation. We conducted a retrospective study to determine whether the size of the liver resection and the estimated blood loss (EBL) impact these laboratory values in the first week (early) and third week (late) postoperatively. Methods: Demographics and peri-operative data of 34 donors undergoing right hepatectomy were analysed by Spearman’s correlation (data in means  SD, P o 0.05 = statistically significant). Re-admissions for pleural effusions were tracked. Results: Donors were 26–56 (43.3  9.1) years old, body mass index (kg/m 2 ) was 27.7  4.2, liver resected (%) was 58  7 and EBL (mL) was 1505  927. A larger hepatectomy correlated with lower Alb at 3 weeks (P = 0.03) and also with a higher early (P = 0.025) and late Tbili (P = 0.037). Larger blood loss determined low Alb in the first week (P = 0.013), still noticeable 3 weeks postoperatively (P = 0.047). Re-admissions for pleural effusion were not associated with the size of the liver resection or postoperative Alb changes. Conclusions: A remaining liver size-dependent reduced synthetic hepatic function may explain the persistent low Alb that becomes apparent at end of the preoperative Albs half-life. A size-related diminished metabolic liver capacity results in early and late elevated Tbili. Prospective studies are needed to better understand the impact of resection size on hepatic physiology, donor care and clinical outcomes. The United Network for Organ Sharing reported a total of 288 live liver donations for liver transplanta- tion in the US in 2006 (1), including all categories of live donor liver resections. The exact number of donor right hepatectomies, the most extensive donation procedure, is not known, but consistently results in temporary biochemical and haematologic alterations in the donor (2, 3). Understanding of the peri- operative physiological changes in this unique, other- wise healthy population is incomplete and difficult to study in such a low-frequency procedure. Albumin (Alb), a plasma protein synthesized by the liver, and bilirubin (Tbili), the end product of haeme metabo- lism, both may be affected by the extent of the right hepatic resection. We conducted a retrospective study of our first 34 consecutive donors undergoing right hepatectomy, to systematically investigate the impact of the extent of liver resection and the estimated intra- operative blood loss on Alb and Tbili early (first week) and late (third week) postoperatively. The clinical correlation of our results with postoperative pleural effusions was evaluated. Patients and methods Following institutional review board approval, demo- graphic and peri-operative outcome data for 34 con- secutive donors undergoing right hepatectomy were reviewed. Data collection included the percent of liver resected (PLR), estimated blood loss (EBL), results of serial plasma Alb and Tbili measurements as well as the re-admission rate for the treatment of pleural effusion. To determine the size of the hepatic resection in percent, the total liver weight was estimated pre- operatively by reformatted 3-D computed tomo- graphy liver volumetry. Subtracting the actual graft Liver International (2007) c  2007 The Authors. Journal compilation c  2008 Blackwell Munksgaard 95 Liver International ISSN 1478-3223