Factors Associated With Changes in Coagulation Profiles After Living Donor Hepatectomy

• Published in: Transplantation proceedings Vol. 42; no. 7; pp. 2430 - 2435
• Main Authors: Kim, Y.K, Shin, W.J, Song, J.G, Jun, I.G, Kim, H.Y, Seong, S.H, Sang, B.H, Hwang, G.S
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01-09-2010; Elsevier
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Blood Coagulation - physiology; Blood Coagulation Disorders - etiology; Blood Pressure; Cholecystectomy; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepatectomy - methods; Humans; International Normalized Ratio; Liver, biliary tract, pancreas, portal circulation, spleen; Living Donors; Male; Medical sciences; Middle Aged; Partial Thromboplastin Time; Postoperative Complications - blood; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology; Medicine; Blood coagulation; Treatment; Surgery; Living donor; Cause; Graft; Transplantation; Change; Profile; Hepatectomy
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.04.069

Abstract Background Hepatic resection may be associated with postoperative coagulopathy. However, there is limited information about the predictors affecting coagulopathy after donor hepatectomy. We evaluated the contributors of maximal changes in prothrombin time (PT), activated thromboplastin time (aPTT), and platelet count in the development of postoperative coagulopathy. Methods We retrospectively analyzed 864 living donors, all of whom received general anesthesia using desflurane, isoflurane, or sevoflurane. A coagulation derangement was defined as one or more of the following events postoperatively: peak PT >1.5 international normalized ratio (INR; highest quartile of PT), peak aPTT >46 seconds (highest quartile of aPTT), or nadir platelet count <100 × 109 /L. Factors were evaluated by univariate and multivariate logistic regression analysis to identify predictors of coagulopathy. Results Mean postoperative peak PT, peak aPTT, and nadir platelet count were 1.4 ± 0.2 INR, 43.8 ± 23.7 seconds, and 155.9 ± 37.3 × 109 /L, respectively, with 39.4% of donors being at the risk for coagulation derangement. Multivariate logistic regression analysis revealed that predictors of such derangement included anesthesia duration, remnant liver volume, and body mass index (BMI). However, coagulation derangement was not independently associated with age, gender, volatile anesthetics, central venous pressure, fatty change in the liver, estimated blood loss, or intraoperative hypotensive episodes. Conclusion We found that long anesthesia duration, low BMI, and small remnant liver volume were predictors of coagulation derangement. These results provide a better understanding of risk factors affecting changes in coagulation profiles after living donor hepatectomy.