*Purpose: Preclinical data suggest that supplementation of omega-3 fatty acids may be beneficial in liver resections, by ameliorating ischemic injury during the surgical procedure. In this trial, we will assess the use of a fish oil-based lipid emulsion as a potential preconditioning strategy for the reduction of ischemic injury in living liver donation.

*Methods: This trial was a prospective, open-label, single-arm trial to assess the effect of two preoperative doses of 10% purified fish oil-based lipid emulsion (Omegaven, Fresenius-Kabi) on outcome after living donor right hepatectomy. Live liver donors scheduled to undergo right hepatectomy were given preoperative infusions of Omegaven 100 mL, on the day prior to surgery and on the morning of surgery. Primary endpoint was postoperative change in liver enzymes (AST and ALT). Secondary endpoints were postoperative change in inflammatory biomarkers and the occurrence of adverse events within 30 days of liver donation.

*Results: Ten donors were enrolled in the trial from January to July of 2018. Nine donors completed the trial. One subject did not undergo liver donation due to moderate steatosis upon liver biopsy and was dropped from the trial. All patients underwent fully laparoscopic right hepatectomy and mean operative time was 273 minutes. Serum levels of omega-3 fatty acid significantly increased following two infusions of Omegaven (mean 145.0 ug/mL to 199.4 ug/mL, p=0.034), while omega-6 fatty acid decreased (mean 1090 ug/mL to 977.8 ug/mL, p=0.063). Estimated blood loss during surgery was 238.9 ml and none of the patients received intraoperative red blood cell (RBC) transfusions. One patient required postoperative RBC transfusion. Peak postoperative aspartate aminotransferase and alanine aminotransferase levels were 205.3 U/L and 233.1 U/L, respectively. Values peaked on the day of surgery or postoperative day 1 and continued to decline during the first 5 days. The serum total bilirubin peaked on postoperative day 1 with a mean of 2.7 mg/dL. The peak mean prothrombin time international normalized ratio was 1.65. All donors were discharged without complications.

*Conclusions: Preoperative intravenous infusion of Omegaven in living donors undergoing right hepatectomy was associated with significant increase in serum omega-3 fatty acid levels and was not associated with perioperative adverse events, including postoperative bleeding.

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