Hepatectomy-related hypophosphatemia may predict donor liver dysfunction in live-donor liver transplantation

Background: Hypophosphatemia after living-donor liver donation was recently reported to not be linked to donor morbidity. However, few studies have examined the relationship between hypophosphatemia and hepatic function after hepatectomy in live liver donors. In this study, we investigated the relationship between postoperative hypophosphatemia and hepatic function in living donors after hepatectomy.

Methods: We collected data from 102 live-donor hemihepatectomy cases. The severity of hypophosphatemia was categorized as mild (1.5-2.5 mg/dL), moderate (1.1-1.5 mg/dL), or severe (<1.0 mg/dL). We compared complications among the groups and factors possibly related to the postoperative nadir phosphorus levels.

Results: One hundred cases (98%) developed mild (n = 56), moderate (n = 25), or severe (n = 19), hypophosphatemia. Serum phosphate levels began to fall on postoperative day (POD) 2, reaching a nadir (1.89 ± 0.72 mg/dL) on POD 3. There was a significant difference in the incidence of postoperative liver dysfunction among the 3 groups (P = .027). Moreover, a correlation was identified between the incidence and the hypophosphatemia severity (r = 0.549; P = .023). The nadir phosphorous level significantly and negatively correlated with the peak of total bilirubin (P = .001) and international normalized ratio (P = .004). Patients with intravenous phosphorus replacement showed better hepatic function and a lower incidence of hepatic dysfunction among the severely hypophosphatemic group.

Conclusion: Hypophosphatemia was predictive of hepatic dysfunction after hepatectomy in living donors. Phosphorus replacement may improve recovery of hepatic function among living liver donors.