Influence of surgical technique in donor hepatectomy on immediate and short-term living donor outcomes – A systematic review of the literature, meta-analysis and expert panel recommendations

Yee L. Cheah, Julie Heimbach, Choon Hyuck David Kwon, James Pomposelli, Dianne La Pointe Rudow, Dieter Broering, Michael Spiro, Dimitri Aristotle Raptis, John P. Roberts

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: : There are currently no guidelines pertaining to ERAS pathways in living donor hepatectomy. Objectives: : To identify whether surgical technique influences immediate and short-term outcomes after living liver donation surgery. Data sources: : Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. Methods: : Systematic review and meta-analysis following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel (CRD42021260707). Endpoints were mortality, overall complications, serious complications, bile eaks, pulmonary complications, estimated blood loss and length of stay. Results: : Of the 2410 screened articles, 21 articles were included for final analysis; 3 observational, 13 retrospective cohort, 4 prospective cohort studies and 1 randomized trial. Overall complications were higher with right versus left hepatectomy (26.8 vs 20.8%; OR 1.4, p = 0.010). Donors after left hepatectomy had shorter length of stay (MD 1.4 days) compared to right hepatectomy. There was no difference in outcomes after right donor hepatectomy with versus without middle hepatic vein. We had limited data on the influence of incision type and minimally-invasive approaches on living donor outcomes, and no data on the effect of operative time on donor outcomes. Conclusions: : Left donor hepatectomy should be preferred over right hepatectomy as it is related to improved donor short-term outcomes (QOE; Moderate | Grade of Recommendation; Strong). Right donor hepatectomy with or without MHV has equivalent outcomes (QOE; Moderate | Grade of Recommendation; Strong); no preference is recommended, decision should be based on program's experience and expertise. No difference in outcomes was observed related to incision type, minimally invasive vs open (QOE; Low | Grade of Recommendation; Weak); no preference can be recommended. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalClinical Transplantation
DOIs
StateAccepted/In press - 2022

Keywords

  • ERAS
  • complication
  • living liver donation
  • minimally-invasive

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