Clinical utility of postoperative phosphate recovery profiles to predict liver insufficiency after living donor hepatectomy

Oscar K Serrano; Steven J Mongin; Danielle Berglund; Varshita Goduguchinta; Apoorva Reddy; David M Vock; Varvara Kirchner; Raja Kandaswamy; Timothy L Pruett; Srinath Chinnakotla

doi:10.1016/j.amjsurg.2019.01.006

Clinical utility of postoperative phosphate recovery profiles to predict liver insufficiency after living donor hepatectomy

Am J Surg. 2019 Aug;218(2):374-379. doi: 10.1016/j.amjsurg.2019.01.006. Epub 2019 Jan 11.

Affiliations

¹ Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA. Electronic address: serra061@umn.edu.
² Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA.
³ Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
⁴ Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.

PMID: 30660322
DOI: 10.1016/j.amjsurg.2019.01.006

Abstract

Background: Living donor hepatectomy (LDH) is associated with significant postoperative hypophosphatemia.

Methods: From January 1997 through July 2017, we performed 176 LDH and compared donors who developed liver insufficiency (LI) to those that did not within 30 days of LDH. Using smoothing splines, we constructed a mixed-effects model and assessed receiver operating characteristic curves.

Results: Of the 176 donors, 161 were included in our study and 10 (6.2%) developed LI. The cohorts differed in minimum observed phosphate levels (1.77 mg/dL, LI cohort; 2.01 mg/dL No LI cohort) at a median nadir of 1.6 days (38 h) postoperatively (p = 0.003). In the ROC analysis, intraoperative time and postoperative phosphate levels best predicted LI (sensitivity, 90%; specificity, 55.6%).

Conclusion: Mean postoperative phosphate profiles differ significantly between those patients who develop LI and those who do not in the first 38 h after LDH.

Keywords: Hypophosphatemia; Liver insufficiency; Living donor hepatectomy.

MeSH terms

Adult
Female
Hepatectomy*
Hepatic Insufficiency / epidemiology*
Humans
Living Donors
Male
Phosphates / blood*
Postoperative Complications / epidemiology*
Postoperative Period
Predictive Value of Tests
Recovery of Function
Retrospective Studies
Tissue and Organ Harvesting*

Substances

Phosphates