Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12757
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
Processing time: 221 Days and 22.6 Hours
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.
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.