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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2015; 21(45): 12757-12766
Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12757
Fluid management in living donor hepatectomy: Recent issues and perspectives
Seong-Soo Choi, Sung-Hoon Kim, Young-Kug Kim
Seong-Soo Choi, Sung-Hoon Kim, Young-Kug Kim, Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea
Author contributions: Choi SS performed the literature review and wrote the manuscript; Kim SH performed the literature review; and Kim YK performed the literature review and provided expertise and critical revision of the manuscript.
Conflict-of-interest statement: The authors report no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Young-Kug Kim, MD, PhD, Professor, Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-Dong, Songpa-Gu, Seoul 138-736, South Korea. kyk@amc.seoul.kr
Telephone: +82-2-30105976 Fax: +82-2-30106790
Received: April 28, 2015
Peer-review started: May 7, 2015
First decision: June 2, 2015
Revised: July 28, 2015
Accepted: October 20, 2015
Article in press: October 20, 2015
Published online: December 7, 2015
Abstract

The importance of the safety of healthy living liver donors is widely recognized during donor hepatectomy which is associated with blood loss, transfusion, and subsequent post-operative morbidity. Although the low central venous pressure (CVP) technique can still be effective, it may not be advantageous concerning the safety of healthy donors undergoing hepatectomy. Emerging evidence suggests that stroke volume variation (SVV), a simple and useful index for fluid responsiveness and preload status in various clinical situations, can be applied as a guide for fluid management to reduce blood loss during living donor hepatectomy. Synthetic colloid solutions are also associated with serious adverse events such as the use of renal replacement therapy and transfusion in critically ill or septic patients. However, it is uncertain whether the intra-operative use of colloid solution is associated with similarly adverse effects in patients undergoing living donor hepatectomy. In this review article we discuss the recent issues regarding the low CVP technique and the high SVV method, i.e., maintaining 10%-20% of SVV, for fluid management in order to reduce blood loss during living donor hepatectomy. In addition, we briefly discuss the effects of intra-operative colloid or crystalloid administration for surgical rather than septic or critically ill patients.

Keywords: Donor hepatectomy, Central venous pressure, Stroke volume variation, Fluid, Synthetic colloid

Core tip: The low central venous pressure technique can still be effective for reducing blood loss during hepatectomy. However, it may not be advantageous regarding the safety of healthy donors undergoing hepatectomy. Therefore, to reduce blood loss during donor hepatectomy, we propose an alternative fluid management technique using a high stroke volume variation method. For the type of fluid, the use of a non-lactate-containing crystalloid solution is advisable during donor hepatectomy. Colloid administration should be carefully determined depending upon each clinical situation of donor hepatectomy, although future studies will be required to elucidate the effect of colloid solutions on donor outcomes.