Niemann CU et al. (2007) Central venous pressure monitoring during living right donor hepatectomy. Liver Transpl 13: 266–271

A major concern during living-donor liver transplantation is donor blood loss and its associated morbidity and mortality. As low central venous pressure (CVP) is believed to reduce blood loss during liver resection, CVP monitoring is standard practice during living-donor hepatectomies. To see whether this rationale was supported by evidence, Niemann and colleagues investigated the effect of CVP monitoring on intraoperative management and outcomes of living-donor hepatectomies.

The authors retrospectively analyzed 50 patient records of adult-to-adult, living-donor, right-lobe hepatectomies performed at a single center in San Francisco between May 2002 and October 2005. In total, 31 patients underwent intraoperative catheterization to monitor CVP, and 19 patients were not catheterized. The presence of a central venous catheter did not result in decreased estimated blood loss or intraoperative fluid administration. There was no correlation between fluid administration and estimated blood loss in either group; this result might be because a policy of fluid restriction was applied to all patients. There were no differences in operating time, postanesthesia care-unit stay, or hospital stay. No difference was observed between the groups for the frequency of complications either during hospitalization or at the 3-month follow-up.

The authors conclude that intraoperative fluid requirements and blood loss are equivalent in patients who undergo living-donor, right-lobe hepatectomies, with or without central venous catheterization. CVP monitoring might not, therefore, be necessary during right-lobe liver donation in centers with extensive experience in living-donor hepatectomies.