The effects of intermittent inflow occlusion and hepatic steatosis on postoperative liver functions in living liver donors undergoing right hepatectomy

Background: Intermittent inflow occlusion (IIO) is a safe, effective method to reduce blood loss during liver resection and preserve function even among patients with underlying diseases such as steatosis and cirrhosis. Therefore, we evaluated the impact of IIO on postoperative liver function tests (LFT) and on morbidity among living liver donors undergoing a right hepatectomy, including donors with mild degrees (5%30%) of macrovesicular steatosis (MaS). Methods: We retrospectively reviewed the medical records of 186 living liver donors from August 2008 to September 2010. Donors were divided into two groups according to group IIO (n = 81) versus Controls (no IIO, n = 105). Within each group, donors were subdivided to evaluate Peak values of LFTs and complications into according the degree of MaS: group I-5 (n = 36); IIO + <5% MaS, group I-30 (n = 45); IIO + 5%30% MaS, group C-5 (n = 55); Control + <5% MaS, and group C-30 (n = 50); Control + 5%30% MaS. Results: Peak aspartate aminotransferase (AST) and alanine aminotransferase (ALT) among IIO were significantly higher than Non-IIO. These values in groups I-5 and I-30 were significantly higher than groups C-5 and C-30, respectively (all, P <.01). The overall postoperative complications were comparable between groups IIO and Non-IIO, but significantly higher among group I-30 than groups I-5 (P = 0.024) and C-30 (P =.012). Conclusions: Application of IIO in donors with mild macrosteatosis undergoing right hepatectomy showed significantly higher postoperative peak liver functions tests and number of overall complications than those without IIO.