Life-threatening hypophosphatemia after right hepatic lobectomy for live donor adult liver transplantation

Abstract

Life-threatening hypophosphatemia (phosphorus < 1.0 mg/dL) has been reported only once after liver resection for tumor and was associated with a significant increase in postoperative complications. Hypophosphatemia is associated with reversible cardiac dysfunction, hypoventilation, and impaired immunity. The purpose of this study was to determine the incidence of hypophosphatemia after elective right hepatic lobectomy for live donor adult liver transplantation (

Hypophosphatemia and recovery of post-hepatectomy liver insufficiency

“…In two retrospective cohort studies including respectively 35 and 44 patients undergoing major hepatectomies, 67% and 61.3% rates of HP were identified (13,14). In the living liver donor population, retrospective reports showed HP to occur in 65.9% to 70% of patients after right hepatectomy (15,25,26). We observed a slightly lower proportion of HP patients (55.5%), which can be related to larger sample size, routine post-operative repletion of phosphate, and/or inclusion of all extent of hepatectomies.…”

“…Some authors have reported increased morbidity in patients with HP, including prolonged mechanical ventilation time and longer length of stay (13,14,25,26). They advocated for early and aggressive repletion of serum phosphate after hepatectomy to prevent surgical complications (13,14,25,26). With a sample size ten times larger than these previous studies, our study did not reveal a difference in post-operative morbidity between HP and NP (5.8% vs. 6.7%; P=0.56).…”

Early and late complications in the right-lobe adult living donor

“…Severe hypophosphatemia was a universal event among donors and may have contributed to some of the observed complications. 23 A recent multicenter survey conducted in five Asian liver transplantation centers reported complications and long-term outcomes in 1,058 live donors; more than half of these were right-lobe donors (561 of 1,058 donors). 2 Although the overall morbidity rate was 15.8%, right-lobe donors had a greater incidence of complications (28%) and more serious complications compared with left-lateral segment (9%) and left-lobe donors (7.5%), respectively.…”

“…Alterations in phosphorus metabolism can lead to severe hypophosphatemia in the early postoperative period that is associated with potential neurological, cardiac, and pulmonary complications. 23 Aggressive repletion of phosphorous can avoid severe hypophosphatemia and may reduce complications. 23 Routine use of prophylactic measures to avoid deep venous thrombosis and pulmonary complications are the mainstay of postoperative management in any surgical patient.…”

“…23 Aggressive repletion of phosphorous can avoid severe hypophosphatemia and may reduce complications. 23 Routine use of prophylactic measures to avoid deep venous thrombosis and pulmonary complications are the mainstay of postoperative management in any surgical patient. Incentive spirometry, early ambulation, and physical therapy provide the best opportunity to avoid these complications.…”