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 10³/mm³, and no case showed a platelet count of < 50 x 10³/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.