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

Life-threatening hypophosphatemia (phosphorus < 1.0 mg/dL) has been reporte d only once after liver resection for tumor and was associated with a signi ficant increase in postoperative complications. Hypophosphatemia is associa ted with reversible cardiac dysfunction, hypoventilation, and impaired immu nity. The purpose of this study was to determine the incidence of hypophosp hatemia after elective right hepatic lobectomy for live donor adult liver t ransplantation (LDALT), investigate the associated complication rate and su rgical outcome of live liver donors, and determine the efficacy of prospect ive treatment with phosphate repletion as part of total parenteral nutritio n (TPN). Evaluation of 30 donors who provided 30 right-lobe grafts between December 1998 and January 2000 was performed. Of the initial 18 live liver donors (group 1), 10 donors were treated with TPN that contained slightly m ore (35 +/- 8 mmol/d) than the recommended daily allowance (RDA) of phospho rus (30 mmol/d) starting on postoperative day 1. The last 12 donors (group 2) were prospectively studied and administered similar TPN with 2 times the RDA for phosphorus (60 mmol/d), All donors in group 1 developed hypophosph atemia that was either life threatening (phosphorus < 1.0 mg/dL) in 70% or severely depleted (phosphorus, 1.5 to 1.1 mg/dL) in 30%, With more aggressi ve phosphate repletion (group 2), only 8% developed life-threatening (phosp horus < 1.0 mg/dL) hypophosphatemia and 30% developed severe (phosphorus, 1 .1 to 1.5 mg/dL) hypophosphatemia. Results suggest that hypophosphatemia is a universal event after LDALT and may have contributed to the observed com plications in this study. Repletion of phosphorus at mice the RDA abrogates the incidence of hypophosphatemia and may reduce donor morbidity. Institut ions performing LDALT should carefully monitor Live liver donors for hypoph osphatemia and correct abnormal phosphate levels. Additional studies are ne eded to determine whether more aggressive parenteral repletion can prevent postoperative hypophosphatemia and thus improve outcomes.