| Changes of Coagulation Status and Implication for the Use of Epidural Catheter after Donor Right Hepatectomy. |
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Soo Joo Choi, Mi Sook Gwak, Gaab Soo Kim, Jun Yong Lee, Tae Hyeong Kim, Jin Kyung Kim, Chung Soo Kim, Ik Soo Chung |
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Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. gwakms@smc.samsung.co.kr |
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| Abstract |
BACKGROUND
Living donors for liver transplantations may have a low pain threshold and should be given effective postoperative pain control. However, epidural catheterization has been the subject of intense debate because of the possibility of severe coagulation derangement after a right hepatectomy. This study examined the changes in the coagulation status in right lobe donors.
METHODS
The charts and computerized hospital data of 261 consecutive living donors who had undergone right hepatectomy were retrospectively reviewed. The coagulation profile including the platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT) was analyzed at the preoperative period, immediately after surgery, and 5 days after surgery.
RESULTS
The platelet count decreased significantly from immediately after surgery until postoperative day (POD) 5 (P < 0.001). Nineteen donors (7.3%) had a minimum platelet count of < 100 x 10(3)/mm3, and no case showed a platelet count of < 50 x 10(3)/mm3. The PT increased significantly and reached at peak at POD 1 (1.56 +/- 0.19 INR), and the PT values until POD 5 were significantly different from the preoperative values (P < 0.001). However, the peak PT was > 2.0 INR in only 4 donors (1.5%). The aPTT immediately after surgery showed severe prolongation (P < 0.001), but recovered rapidly on POD 1.
CONCLUSIONS
Right lobe donors showed postoperative coagulation derangement but the changes appear to be acceptable for the maintenance and removal of the epidural catheters. These results suggest that careful epidural catheterizations are relatively safe in right lobe donors. |
| Key Words:
coagulation; epidural catheter; living donor; right hepatectomy |
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