As the only curative treatment for end-stage liver diseases, liver transplantation has been
widely carried out around the world. The shortage of organs from deceased donors facilitate
the adoption of living donor liver transplantation. Living donor hepatectomy is the most
massive operation a healthy person could undergo, so donor safety is of utmost importance.
However, previous studies focused on the outcomes of liver transplant recipients. There are
still many uncertainties about the recovery in living liver donors.
The body microorganisms that reside in the human intestinal tract, referred to as the gut
microbiota, are essential to human metabolism and immunity. The physiological functions of
microbiota include defense against pathogens, providing nutrients such as vitamin B12 folate
and vitamin K, and modulating gut integrity and permeability. Despite relatively stable
microbiota during life, different illnesses, surgeries, medications dietary factors, and
lifestyle changes could contribute to the imbalance of ecosystems resulting many
gastrointestinal and extra-gastrointestinal disorders. Many researches have established a
relationship between the gut microbiome and patients with liver disease such as liver
cirrhosis, alcoholic liver disease and obesity related liver diseases etc. These liver
disorders are associated with bacterial overgrowth, dysbiosis, and increased intestinal
permeability. However, the relationship between hepatectomy and microbiota has not been fully
investigated, especially in healthy liver donors.
Many routine perioperative management can impact the state of the microbiome and therefore
can impact clinical outcomes, like bowel preparation and antibiotics. Potential factors
affecting the gut microbiota also include perioperative manipulation, stress released
hormones, and opioids. Maintenance of proper anesthetic depth is beneficial to attenuate
surgical stress. However, general anesthesia including volatile anesthetics and opioids, is
associated with altered gut microbiota. Therefore, regional anesthesia and analgesia which
effectively attenuating surgical stress while efficiently reducing general anesthetics
consumption, seem to provide promising advantages. Epidural analgesia has been proved to
improve gastrointestinal function in major abdominal and thoracic surgery. However, the
effect of perioperative epidural anesthesia and analgesia on microbiota is not clear.