TY - JOUR
T1 - 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
AU - the ERAS4OLT.org Working Group: Claus Niemann, San Francisco, CA, USA, Joerg-Matthias Pollok, London, UK, Marina Berenguer, Valencia, Spain, Shahi Abdul Ghani, London, UK and Ka Siu Fan, London, UK
AU - Cheah, Yee L.
AU - Heimbach, Julie
AU - Kwon, Choon Hyuck David
AU - Pomposelli, James
AU - Rudow, Dianne La Pointe
AU - Broering, Dieter
AU - Spiro, Michael
AU - Raptis, Dimitri Aristotle
AU - Roberts, John P.
N1 - Publisher Copyright:
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2022/10
Y1 - 2022/10
N2 - Background: There are currently no guidelines pertaining to ERAS pathways in living donor hepatectomy. Objectives: The aim of this study was 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; three observational, 13 retrospective cohort, four prospective cohort studies, and one randomized trial. Overall complications were higher with right versus left hepatectomy (26.8% vs. 20.8%; OR 1.4, P =.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.
AB - Background: There are currently no guidelines pertaining to ERAS pathways in living donor hepatectomy. Objectives: The aim of this study was 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; three observational, 13 retrospective cohort, four prospective cohort studies, and one randomized trial. Overall complications were higher with right versus left hepatectomy (26.8% vs. 20.8%; OR 1.4, P =.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.
KW - ERAS
KW - complication
KW - living liver donation
KW - minimally invasive
UR - http://www.scopus.com/inward/record.url?scp=85142429261&partnerID=8YFLogxK
U2 - 10.1111/ctr.14703
DO - 10.1111/ctr.14703
M3 - Article
C2 - 35538019
AN - SCOPUS:85142429261
SN - 0902-0063
VL - 36
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 10
M1 - e14703
ER -