The Effects of Acute Hyperglycemia Resulting From Hepatic Inflow Occlusion During Living Donor Right Hepatectomy

A. Intermittent hepatic inflow occlusion (IHIO) is widely used during major hepatectomy, however, the uncertainty of how IHIO affects donor safety limits the applicability of this maneuver for living liver donors. Reperfusion hyperglycemia secondary to IHIO is one of factors responsible for the uncertainty. We aimed to evaluate whether IHIO induces hyperglycemia in healthy donors as in liver disease patients as well as hyperglycemia affects donor outcomes. B. We prospectively observed 158 living donors undergoing right hepatectomy. Blood glucose concentrations were measured at predetermined time points. C. Thirty-two (20.3%) donors developed hyperglycemia (maximum glucose concentration > 180 mg/dl). Binary logistic regression determined that >30 min IHIO (vs. 0 min, OR 17.58, 95% CI 3.44-89.90, P=0.001) was the sole independent risk factor for hyperglycemia. Hyperglycemia was transient: glucose concentration dropped rapidly after the last IHIO and reached normal range within 2 hours. Univariate analyses showed that normoglycemic and hyperglycemic groups were comparable regarding overall (56.3% vs. 56.3%) and major (7.1% vs. 12.5%, P=0.301) complication. Biliary (19.0% vs. 21.9%, P=0.756) and surgical site infection (4.0% vs. 6.3%, P=0.609) were also comparable as well as hospital stay (13 d vs. 12 d, P=0.508). Multiple linear regression showed that hyperglycemia was not associated with the extent of hepatocytes injury demonstrated by the peak postoperative transaminase concentrations (AST, β 52.26, SE 35.75, P=0.149; ALT, β 23.34, SE 37.56, P=0.537).Figure: No Caption available.D. IHIO induced hyperglycemia in living donor hepatectomy, however, the impact of hyperglycemia was not significant. It was recommended that acute hyperglycemic response resulting from IHIO does not limit the applicability of IHIO for living liver donors.