1
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Xiao J, Zeng RW, Lim WH, Tan DJH, Yong JN, Fu CE, Tay P, Syn N, Ong CEY, Ong EYH, Chung CH, Lee SY, Koh JH, Teng M, Prakash S, Tan EX, Wijarnpreecha K, Kulkarni AV, Liu K, Danpanichkul P, Huang DQ, Siddiqui MS, Ng CH, Kow AWC, Muthiah MD. The incidence of adverse outcome in donors after living donor liver transplantation: A meta-analysis of 60,829 donors. Liver Transpl 2024; 30:493-504. [PMID: 38015449 DOI: 10.1097/lvt.0000000000000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
The scarcity of liver grafts has prompted developments in living donor liver transplantations (LDLT), with previous literature illustrating similar outcomes in recipients compared to deceased donor transplants. However, significant concerns regarding living donor morbidity and mortality have yet to be examined comprehensively. This study aims to provide estimates of the incidence of various outcomes in living liver donors. In this meta-analysis, Medline and Embase were searched from inception to July 2022 for articles assessing the incidence of outcomes in LDLT donors. Complications in the included studies were classified into respective organ systems. Analysis of incidence was conducted using a generalized linear mixed model with Clopper-Pearson intervals. Eighty-seven articles involving 60,829 living liver donors were included. The overall pooled incidence of complications in LDLT donors was 24.7% (CI: 21.6%-28.1%). The incidence of minor complications was 17.3% (CI: 14.7%-20.3%), while the incidence of major complications was lower at 5.5% (CI: 4.5%-6.7%). The overall incidence of donor mortality was 0.06% (CI: 0.0%-0.1%) in 49,027 individuals. Psychological complications (7.6%, CI: 4.9%-11.5%) were the most common among LDLT donors, followed by wound-related (5.2%, CI: 4.4%-6.2%) and respiratory complications (4.9%, CI: 3.8%-6.3%). Conversely, cardiovascular complications had the lowest incidence among the subgroups at 0.8% (CI: 0.4%-1.3%). This study presents the incidence of post-LDLT outcomes in living liver donors, illustrating significant psychological, wound-related, and respiratory complications. While significant advancements in recent decades have contributed towards decreased morbidity in living donors, our findings call for targeted measures and continued efforts to ensure the safety and quality of life of liver donors post-LDLT.
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Affiliation(s)
- Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clarissa Elysia Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Phoebe Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Biostatistics & Modelling Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Christen En Ya Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Elden Yen Hng Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Charlotte Hui Chung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shi Yan Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jia Hong Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Margaret Teng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Sameer Prakash
- Department of Internal Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Eunice Xx Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Anand V Kulkarni
- Department of Liver Transplantation, AIG Hospitals, Hyderabad, India
| | - Ken Liu
- A.W. Morrow Gastroenterology and Liver Centre, Australian Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Liver Injury and Cancer Program, Centenary Institute of Cancer Medicine and Cell Biology, Sydney, New South Wales, Australia
| | - Pojsakorn Danpanichkul
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mohammad Shadab Siddiqui
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alfred Wei Chieh Kow
- National University Centre for Organ Transplantation, National University Health System, Singapore
- Department of Surgery, Division of Hepatobiliary & Pancreatic Surgery, National University Hospital, Singapore
- Division of Surgical Oncology, National University Cancer Institute, Singapore
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
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Zhang L, Yang Y, Xie L, Zhou Y, Zhong Z, Ding J, Wang Z, Wang Y, Liu X, Yu F, Wu J. JCAD deficiency delayed liver regenerative repair through the Hippo-YAP signalling pathway. Clin Transl Med 2024; 14:e1630. [PMID: 38509842 PMCID: PMC10955226 DOI: 10.1002/ctm2.1630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND AND AIMS Liver regeneration retardation post partial hepatectomy (PH) is a common clinical problem after liver transplantation. Identification of key regulators in liver regeneration post PH may be beneficial for clinically improving the prognosis of patients after liver transplantation. This study aimed to clarify the function of junctional protein-associated with coronary artery disease (JCAD) in liver regeneration post PH and to reveal the underlying mechanisms. METHODS JCAD knockout (JCAD-KO), liver-specific JCAD-KO (Jcad△Hep) mice and their control group were subjected to 70% PH. RNA sequencing was conducted to unravel the related signalling pathways. Primary hepatocytes from KO mice were treated with epidermal growth factor (EGF) to evaluate DNA replication. Fluorescent ubiquitination-based cell cycle indicator (FUCCI) live-imaging system was used to visualise the phases of cell cycle. RESULTS Both global and liver-specific JCAD deficiency postponed liver regeneration after PH as indicated by reduced gene expression of cell cycle transition and DNA replication. Prolonged retention in G1 phase and failure to transition over the cell cycle checkpoint in JCAD-KO cell line was indicated by a FUCCI live-imaging system as well as pharmacologic blockage. JCAD replenishment by adenovirus reversed the impaired DNA synthesis in JCAD-KO primary hepatocyte in exposure to EGF, which was abrogated by a Yes-associated protein (YAP) inhibitor, verteporfin. Mechanistically, JCAD competed with large tumour suppressor 2 (LATS2) for WWC1 interaction, leading to LATS2 inhibition and thereafter YAP activation, and enhanced expression of cell cycle-associated genes. CONCLUSION JCAD deficiency led to delayed regeneration after PH as a result of blockage in cell cycle progression through the Hippo-YAP signalling pathway. These findings uncovered novel functions of JCAD and suggested a potential strategy for improving graft growth and function post liver transplantation. KEY POINTS JCAD deficiency leads to an impaired liver growth after PH due to cell division blockage. JCAD competes with LATS2 for WWC1 interaction, resulting in LATS2 inhibition, YAP activation and enhanced expression of cell cycle-associated genes. Delineation of JCADHippoYAP signalling pathway would facilitate to improve prognosis of acute liver failure and graft growth in living-donor liver transplantation.
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Affiliation(s)
- Li Zhang
- Department of Medical Microbiology & ParasitologyMOE/NHC/CAMS Key Laboratory of Medical Molecular VirologySchool of Basic Medical SciencesFudan University Shanghai Medical CollegeShanghaiChina
| | - Yong‐Yu Yang
- Department of Medical Microbiology & ParasitologyMOE/NHC/CAMS Key Laboratory of Medical Molecular VirologySchool of Basic Medical SciencesFudan University Shanghai Medical CollegeShanghaiChina
| | - Li Xie
- Department of Medical Microbiology & ParasitologyMOE/NHC/CAMS Key Laboratory of Medical Molecular VirologySchool of Basic Medical SciencesFudan University Shanghai Medical CollegeShanghaiChina
| | - Yuan Zhou
- Department of Medical Microbiology & ParasitologyMOE/NHC/CAMS Key Laboratory of Medical Molecular VirologySchool of Basic Medical SciencesFudan University Shanghai Medical CollegeShanghaiChina
| | - Zhenxing Zhong
- Institute of PediatricsChildren's Hospital of Fudan UniversityShanghai Key Laboratory of Medical EpigeneticsInternational Co‐Laboratory of Medical Epigenetics and MetabolismInstitutes of Biomedical SciencesFudan University Shanghai Medical CollegeShanghaiChina
| | - Jia Ding
- Jing'an Central District HospitalShanghaiChina
| | - Zhong‐Hua Wang
- Department of Medical Microbiology & ParasitologyMOE/NHC/CAMS Key Laboratory of Medical Molecular VirologySchool of Basic Medical SciencesFudan University Shanghai Medical CollegeShanghaiChina
| | - Yu‐Li Wang
- Department of Medical Microbiology & ParasitologyMOE/NHC/CAMS Key Laboratory of Medical Molecular VirologySchool of Basic Medical SciencesFudan University Shanghai Medical CollegeShanghaiChina
| | - Xiu‐Ping Liu
- Department of Pathology and Laboratory MedicineSchool of Basic Medical SciencesFudan UniversityShanghaiChina
| | - Fa‐Xing Yu
- Institute of PediatricsChildren's Hospital of Fudan UniversityShanghai Key Laboratory of Medical EpigeneticsInternational Co‐Laboratory of Medical Epigenetics and MetabolismInstitutes of Biomedical SciencesFudan University Shanghai Medical CollegeShanghaiChina
| | - Jian Wu
- Department of Medical Microbiology & ParasitologyMOE/NHC/CAMS Key Laboratory of Medical Molecular VirologySchool of Basic Medical SciencesFudan University Shanghai Medical CollegeShanghaiChina
- Department of Gastroenterology & HepatologyZhongshan Hospital of Fudan UniversityShanghaiChina
- Shanghai Institute of Liver DiseasesFudan University Shanghai Medical CollegeShanghaiChina
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Cullen JM, Conzen KD, Pomfret EA. Living Donor Liver Transplantation: Left Lobe or Right Lobe. Surg Clin North Am 2024; 104:89-102. [PMID: 37953043 DOI: 10.1016/j.suc.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Living Donor Liver Transplantation (LDLT) has seen great advancements since its inception in 1988. Herein, the nuances of LDLT are discussed spanning from donor evaluation to the recipient operation. Special attention is given to donor anatomy and graft optimization techniques in the recipient.
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Affiliation(s)
- J Michael Cullen
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), University of Colorado Anschutz, University of Colorado Anschutz Medical Campus, 1635 Aurora Ct, AOP 7th Fl, C-318, Aurora, CO 80045, USA
| | - Kendra D Conzen
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), University of Colorado Anschutz, University of Colorado Anschutz Medical Campus, 1635 Aurora Ct, AOP 7th Fl, C-318, Aurora, CO 80045, USA.
| | - Elizabeth A Pomfret
- Division of Transplant Surgery, Igal Kam, MD Endowed Chair in Transplantation Surgery, Colorado Center for Transplantation Care, Research and Education (CCTCARE), University of Colorado Anschutz Medical Campus, 1635 Aurora Ct, AOP 7th Fl, C-318, Aurora, CO 80045, USA
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4
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Tabrizian P, Yu A, Debnath N, Myers B, Marron T. Immunotherapy and Liver Transplantation: The Future or the Failure? Surg Clin North Am 2024; 104:163-182. [PMID: 37953034 DOI: 10.1016/j.suc.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
A quarter century has passed since the milestone study by Mazzaferro and colleagues on liver transplantation (LT) for hepatocellular carcinoma (HCC). The increasing demand for LT for HCC has led to the continued efforts to expand LT indications. Downstaging to within Milan criteria has been incorporated into the organ allocation policy for HCC in the United States in 2017 and provides acceptable long-term survival. The present review focuses on the rationale of neoadjuvant immune checkpoint inhibitor (ICI) in HCC, the experience of ICI in the pre- and posttransplant setting.
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Affiliation(s)
- Parissa Tabrizian
- Liver Transplant and Hepatobiliary Surgery, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy, New York, NY 10029, USA.
| | - Allen Yu
- Liver Transplant and Hepatobiliary Surgery, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy, New York, NY 10029, USA
| | - Neha Debnath
- Liver Transplant and Hepatobiliary Surgery, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy, New York, NY 10029, USA
| | - Bryan Myers
- Liver Transplant and Hepatobiliary Surgery, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy, New York, NY 10029, USA
| | - Thomas Marron
- Liver Transplant and Hepatobiliary Surgery, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy, New York, NY 10029, USA
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5
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Brown ZJ, Pawlik TM. Top Hepatobiliary Articles from 2022 to Inform Your Cancer Practice. Ann Surg Oncol 2024; 31:75-80. [PMID: 37843669 DOI: 10.1245/s10434-023-14420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
Until recently, there have been only modest therapeutic advances in the treatment of hepatobiliary malignancies. However, the introduction of immune checkpoint inhibitors in combination with targeted therapy or chemotherapy has changed the therapeutic landscape of hepatocellular carcinoma and biliary tract cancers. As such, revisions have been made to guidelines reflecting therapeutic advances for patients who can be considered for surgical options including resection and liver transplantation. This article highlights recently published studies that have impacted both the oncological and surgical approach to the treatment of patients with hepatobiliary malignancies.
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Affiliation(s)
- Zachary J Brown
- Division of Surgical Oncology, Department of Surgery, NYU Langone Health, New York University Grossman Long Island School of Medicine, Mineola, NY, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, James Cancer Hospital, Columbus, OH, USA.
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6
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Reddy MS, Kasahara M, Ikegami T, Lee KW. An international survey of venous thromboembolic events and current practices of peri-operative VTE prophylaxis after living donor hepatectomy. Clin Transplant 2024; 38:e15209. [PMID: 38064308 DOI: 10.1111/ctr.15209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Venous thromboembolic complications are an uncommon but significant cause of morbidity & mortality after live donor hepatectomy . The precise incidence of these events and the current practices of centers performing living donor liver transplantation worldwide are unknown. METHODS An online survey was shared amongst living donor liver transplantation centers containing questions regarding center activity, center protocols for donor screening, peri-operative thromboembolic prophylaxis and an audit of -perioperative venous thromboembolic events after live donor hepatectomy in the previous five years (2016-2020). RESULTS Fifty-one centers from twenty countries completed the survey. These centers had cumulatively performed 11500 living donor liver transplants between 2016-2020. All centers included pre-operative l assessment for thromboembolic risk amongst potential liver donors in their protocols. Testing for inherited prothrombotic conditions was performed by 58% of centers. Dual-mode prophylaxis was the most common practice (65%), while eight and four centers used single mode or no routine prophylaxis respectively. Twenty (39%) and 15 (29%) centers reported atleast one perioperative deep venous thrmobosis or pulmonary embolism event respectively. There was one donor mortality directly related to post-operative pulmonary embolism. Overall incidence of deep venous thrombosis and pulmonary embolism events was 3.65 and 1.74 per 1000 live donor hepatectomies respectively. Significant variations in center practices and incidence of thromboembolic events was identified in the survey primarily divided along world regions. 75% of participating centers agreed on the need for clear international guidelines. CONCLUSION Venous thromboembolic events after live donor hepatectomy are an uncommon but important cause of donor morbidity. There is significant variation in practice among centers. Evidence-based guidelines regarding risk assessment, and peri-operative prophylaxis are needed.
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Affiliation(s)
- Mettu Srinivas Reddy
- Department of Liver Transplantation & Hepatobiliary Surgery, Gleneagles Global Hospital, Chennai, India
| | - Mureo Kasahara
- Center for Organ Transplantation, National Center for Child Health & Development, Tokyo, Japan
| | - Toru Ikegami
- Department of Surgery & Science, Kyushu University, Fukuoka, Japan
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
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Affiliation(s)
- Michael R Lucey
- From the Department of Medicine, Division of Gastroenterology and Hepatology (M.R.L.), the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition (K.N.F.), and the Department of Surgery, Division of Transplantation (D.P.F.), University of Wisconsin, Madison
| | - Katryn N Furuya
- From the Department of Medicine, Division of Gastroenterology and Hepatology (M.R.L.), the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition (K.N.F.), and the Department of Surgery, Division of Transplantation (D.P.F.), University of Wisconsin, Madison
| | - David P Foley
- From the Department of Medicine, Division of Gastroenterology and Hepatology (M.R.L.), the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition (K.N.F.), and the Department of Surgery, Division of Transplantation (D.P.F.), University of Wisconsin, Madison
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8
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Fujiki M, Pita A, Kusakabe J, Sasaki K, You T, Tuul M, Aucejo FN, Quintini C, Eghtesad B, Pinna A, Miller C, Hashimoto K, Kwon CHD. Left Lobe First With Purely Laparoscopic Approach: A Novel Strategy to Maximize Donor Safety in Adult Living Donor Liver Transplantation. Ann Surg 2023; 278:479-488. [PMID: 37436876 DOI: 10.1097/sla.0000000000005988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Evaluate outcome of left-lobe graft (LLG) first combined with purely laparoscopic donor hemihepatectomy (PLDH) as a strategy to minimize donor risk. BACKGROUND An LLG first approach and a PLDH are 2 methods used to reduce surgical stress for donors in adult living donor liver transplantation (LDLT). But the risk associated with application LLG first combined with PLDH is not known. METHODS From 2012 to 2023, 186 adult LDLTs were performed with hemiliver grafts, procured by open surgery in 95 and PLDH in 91 cases. LLGs were considered first when graft-to-recipient weight ratio ≥0.6%. Following a 4-month adoption process, all donor hepatectomies, since December 2019, were performed laparoscopically. RESULTS There was one intraoperative conversion to open (1%). Mean operative times were similar in laparoscopic and open cases (366 vs 371 minutes). PLDH provided shorter hospital stays, lower blood loss, and lower peak aspartate aminotransferase. Peak bilirubin was lower in LLG donors compared with right-lobe graft donors (1.4 vs 2.4 mg/dL, P < 0.01), and PLDH further improved the bilirubin levels in LLG donors (1.2 vs 1.6 mg/dL, P < 0.01). PLDH also afforded a low rate of early complications (Clavien-Dindo grade ≥ II, 8% vs 22%, P = 0.007) and late complications, including incisional hernia (0% vs 13.7%, P < 0.001), compared with open cases. LLG was more likely to have a single duct than a right-lobe graft (89% vs 60%, P < 0.01). Importantly, with the aggressive use of LLG in 47% of adult LDLT, favorable graft survival was achieved without any differences between the type of graft and surgical approach. CONCLUSIONS The LLG first with PLDH approach minimizes surgical stress for donors in adult LDLT without compromising recipient outcomes. This strategy can lighten the burden for living donors, which could help expand the donor pool.
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Affiliation(s)
- Masato Fujiki
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Alejandro Pita
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Jiro Kusakabe
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Kazunari Sasaki
- Department of Surgery, Division of Abdominal Transplant, Stanford University, Palo Alto, CA
| | - Taesuk You
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Munkhbold Tuul
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Cristiano Quintini
- General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Bijan Eghtesad
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Antonio Pinna
- Transplant Center, Cleveland Clinic Florida, Weston, FL
| | - Charles Miller
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Koji Hashimoto
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
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Pillai A, Goldaracena N, Rosenblatt R, Verna EC. CAQ Corner: Evaluation and management of living liver donors. Liver Transpl 2023; 29:1118-1128. [PMID: 37243369 DOI: 10.1097/lvt.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Anjana Pillai
- Division of Gastroenterology, Department of Internal Medicine, Hepatology and Nutrition, University of Chicago Medicine, Chicago, Illinois, USA
| | - Nicolas Goldaracena
- Division of Transplantation, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Russell Rosenblatt
- Center for Liver Disease and Transplantation, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Elizabeth C Verna
- Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA
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Bonaccorsi-Riani E, Daudré-Vignier V, Ciccarelli O, Coubeau L, Iesari S, Castanares-Zapatero D, Collienne C, Annet L, Danse E, Balligand JL, Lefebvre C, Dieu A, Benoit L, Reding R. Improving Safety in Living Liver Donation: Lessons From Intraoperative Adverse Events in 438 Donors Undergoing a Left Liver Resection. Transplant Direct 2023; 9:e1531. [PMID: 37636484 PMCID: PMC10455133 DOI: 10.1097/txd.0000000000001531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 08/29/2023] Open
Abstract
Background Donor safety is paramount in living organ donation. Left liver resections are considered safer than right lobe hepatectomies. However, unexpected intraoperative adverse events (iAEs), defined as any deviation from the ideal intraoperative course, can also occur during left liver resections and may be life threatening or lead to postoperative complication or permanent harm to the donor and recipient. Methods Records of 438 liver living donors (LDs) who underwent 393 left lateral sectionectomies (LLSs) and 45 left hepatectomies (LHs) between July 1993 and December 2018 in a pediatric living-donor liver transplantation center were reviewed for the appearance of iAEs that could have influenced the donor morbidity and mortality and that could have contributed to the improvement of the LD surgical protocol. Results Clinical characteristics of LLS and LH groups were comparable. Nine iAEs were identified, an incidence of 2%, all of them occurring in the LLS group. Seven of them were related to a surgical maneuver (5 associated with vascular management and 2 with the biliary tree approach). One iAE was associated with an incomplete donor workup and the last with drug administration. Each iAE resulted in subsequent changes in the surgical protocol. Donor outcome was at risk by 5 iAEs classed as type a, recipient outcome by 2 iAEs (type b) and both by 2 iAEs (type c). Postoperative complications occurred in 87 LDs (19.9%), with no differences between the LLS and LH groups (P = 0.227). No Clavien-Dindo class IVa or b complications or donor mortality (Clavien-Dindo class V) were observed. Conclusions iAEs debriefings induced changes in our LD protocol and may have contributed to reduced morbidity and zero mortality. iAEs analysis can be used as a quality and safety improvement tool in the context of LD procedures, which may include right liver donation, laparoscopic, and robotic living liver graft procurement.
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Affiliation(s)
- Eliano Bonaccorsi-Riani
- Transplantation and Abdominal Surgery Section, Department of Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
- Institute de Recherche Expérimentale et Clinique – IREC, UCLouvain, Brussels, Belgium
| | - Victoria Daudré-Vignier
- Transplantation and Abdominal Surgery Section, Department of Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Olga Ciccarelli
- Transplantation and Abdominal Surgery Section, Department of Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
- Institute de Recherche Expérimentale et Clinique – IREC, UCLouvain, Brussels, Belgium
| | - Laurent Coubeau
- Transplantation and Abdominal Surgery Section, Department of Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Samuele Iesari
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Christine Collienne
- Adult Intensive Care Unit, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Laurence Annet
- Department of Radiology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Etienne Danse
- Department of Radiology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Jean-Luc Balligand
- Institute de Recherche Expérimentale et Clinique – IREC, UCLouvain, Brussels, Belgium
- Department of Internal Medicine, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Chantal Lefebvre
- Institute de Recherche Expérimentale et Clinique – IREC, UCLouvain, Brussels, Belgium
- Department of Internal Medicine, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Audrey Dieu
- Department of Anesthesia, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Loïc Benoit
- Department of Anesthesia, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Raymond Reding
- Transplantation and Abdominal Surgery Section, Department of Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
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Bailey RE, Pugliesi RA, Borja-Cacho D, Borhani AA. Imaging Evaluation of the Living Liver Donor: A Systems-Based Approach. Radiol Clin North Am 2023; 61:771-784. [PMID: 37495286 DOI: 10.1016/j.rcl.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Liver transplant is the definitive treatment of end-stage liver disease and early hepatocellular carcinoma. The number of liver transplant surgeries done is highly affected by the number and availability of deceased donor organs. Living donor liver transplantation has emerged as an alternative source of donors, increasing the availability of organs for transplant. Many factors must be considered when choosing living donor candidates to maintain a high level of donor safety and organ survival. To that end, potential donors undergo a rigorous pre-donation workup.
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Affiliation(s)
- Ryan E Bailey
- Department of Radiology, Section of Body Imaging, Northwestern University, Feinberg School of Medicine, 676 North Street Clair Street, Ste 800, Chicago, IL 60611, USA
| | - Rosa Alba Pugliesi
- Department of Radiology, Section of Body Imaging, Northwestern University, Feinberg School of Medicine, 676 North Street Clair Street, Ste 800, Chicago, IL 60611, USA
| | - Daniel Borja-Cacho
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amir A Borhani
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Street Clair Street, Ste 800, Chicago, IL 60611, USA.
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12
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Kim SH, Kim KH, Cho HD. Donor safety of remnant liver volumes of less than 30% in living donor liver transplantation: A systematic review and meta-analysis. Clin Transplant 2023; 37:e15080. [PMID: 37529969 DOI: 10.1111/ctr.15080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE This meta-analysis aimed to investigate the acceptability of donor remnant liver volume (RLV) to total liver volume (TLV) ratio (RLV/TLV) being <30% as safe in living donor liver transplantations (LDLTs). METHODS Online databases were searched from January 2000 to June 2022. Pooled odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects model. RESULTS One prospective and seven retrospective studies comprising 1935 patients (164 RLV/TLV <30% vs. 1771 RLV/TLV ≥30%) were included. Overall (OR = 1.82; 95% CI [1.24, 2.67]; p = .002) and minor (OR = 1.88; 95% CI [1.23, 2.88]; p = .004) morbidities were significantly lower in the RLV/TLV ≥30% group than in the RLV/TLV <30% group (OR = 1.82; 95% CI [1.24, 2.67]; p = .002). No significant differences were noted in the major morbidity, biliary complications, and hepatic dysfunction. Peak levels of bilirubin (SMD = .50; 95% CI [.07, .93]; p = .02) and international normalized ratio (SMD = .68; 95% CI [.04, 1.32]; p = .04) were significantly lower in the RLV/TLV ≥ 30% group than in the RLV/TLV <30% group. No significant differences were noted in the peak alanine transferase and aspartate transaminase levels and hospital stay. CONCLUSIONS Considering the safety of the donor as the top priority, the eligibility of a potential liver donor in LDLT whose RLV/TLV is expected to be <30% should not be accepted.
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Affiliation(s)
- Sang-Hoon Kim
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ki-Hun Kim
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hwui-Dong Cho
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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13
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Swiss Academy of Medical Sciences. Medical-ethical guidelines: Living donation of solid organs. Swiss Med Wkly 2023; 153:40126. [PMID: 37774384 DOI: 10.57187/smw.2023.40126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
No abstract available.
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14
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Di Sandro S, Catellani B, Guidetti C, Magistri P, Ballarin R, Pecchi A, Caracciolo D, Guaraldi G, Guerrini GP, Di Benedetto F. Successful living donor liver transplantation from an HIV and HCV positive donor: report from the first case in the world. AIDS 2023; 37:1257-1261. [PMID: 36927959 DOI: 10.1097/qad.0000000000003533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
HIV (human-immunodeficiency-virus) and HCV (hepatitis-C-virus) infections cause millions of deaths across the world every year. Since the introduction of effective therapies for HIV, in the middle of 1990s, and HCV, after 2013, those two untreatable infections became completely controlled. Donor safety is the main goal in living donor liver transplantation (LDLT). An accurate predonation screening is mandatory for excluding risk factors related with any increase of donors' short-term and long-term morbidity. We present the first LDLT from a donor with both HIV and HCV previous infections. Donor and recipient did not experience any complication. Individuals with well controlled HIV/HCV infections and without any risk factors may be suitable for donation of a part of their healthy liver. Abstract video, http://links.lww.com/QAD/C833.
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Affiliation(s)
| | | | | | | | | | | | | | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic (MHMC). Department of Surgical, Medical, Dental, and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
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15
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Kakos CD, Papanikolaou A, Ziogas IA, Tsoulfas G. Global dissemination of minimally invasive living donor hepatectomy: What are the barriers? World J Gastrointest Surg 2023; 15:776-787. [PMID: 37342850 PMCID: PMC10277954 DOI: 10.4240/wjgs.v15.i5.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/16/2023] [Accepted: 03/16/2023] [Indexed: 05/26/2023] Open
Abstract
Minimally invasive donor hepatectomy (MIDH) is a relatively novel procedure that can potentially increase donor safety and contribute to faster rehabilitation of donors. After an initial period in which donor safety was not effectively validated, MIDH currently seems to provide improved results, provided that it is conducted by experienced surgeons. Appropriate selection criteria are crucial to achieve better outcomes in terms of complications, blood loss, operative time, and hospital stay. Beyond a pure laparoscopic technique, various approaches have been recommended such as hand-assisted, laparoscopic-assisted, and robotic donation. The latter has shown equal outcomes compared to open and laparoscopic approaches. A steep learning curve seems to exist in MIDH, mainly due to the fragility of the liver parenchyma and the experience needed for adequate control of bleeding. This review investigated the challenges and the opportunities of MIDH and the barriers to its global dissemination. Surgeons need expertise in liver transplantation, hepatobiliary surgery, and minimally invasive techniques to perform MIDH. Barriers can be categorized into surgeon-related, institutional-related, and accessibility. More robust data and the creation of international registries are needed for further evaluation of the technique and the acceptance from more centers worldwide.
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Affiliation(s)
- Christos Dimitrios Kakos
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
| | - Angelos Papanikolaou
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Georgios Tsoulfas
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
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16
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Li H, Wei L, Zhu M, Zeng Z, Qu W, Zhu Z. A novel approach of intraoperative cholangiography in laparoscopic left lateral sectionectomy in living donor liver transplantation. Surg Endosc 2023:10.1007/s00464-023-10066-1. [PMID: 37081244 DOI: 10.1007/s00464-023-10066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/01/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Accurate division of bile duct during laparoscopic donor hepatectomy in living donor liver transplantation is essential. We here present a novel approach to achieve cholangiography via the bile duct stump of segment IV (B4 stump) during laparoscopic donor hepatectomy in adult-to-pediatric living donor liver transplantation. PATIENTS AND METHODS Donors who underwent laparoscopic left lateral sectionectomy (LLLS) from January 2022 to April 2022 in our liver transplant center were retrospectively analyzed. A total of 32 donors were eventually enrolled into this study. Cholangiography via the B4 stump was performed in 11 donors (B4 group) while indocyanine green (ICG) fluorescence guiding was performed in 21 donors (ICG group). Perioperative data were collected and compared between groups. RESULTS Cholangiography by catheterizing the B4 stump was successfully performed in all 11 donors in the B4 group. The mean time of this procedure was 12.82 ± 9.11 min. Compared to the ICG group, it was more likely to acquire single bile duct orifice on graft in the B4 group (B4: 10/11, 90.91% vs ICG: 9/21, 42.86%) and it was significantly different (p = 0.030). The donors' complications (Clavien-Dindo grade III-IV) were not significantly different. There was one donor developed intraperitoneal effusion in B4 group, while two donors (one bile leakage and one biliary stricture) developed biliary tract related complications in the ICG group. A Roux-en-Y was performed to solve the biliary stricture in the ICG group. The recipients' outcomes were not significantly different between groups. CONCLUSIONS Cholangiography via the B4 stump catheterization is feasible and safe in identifying the bifurcation of bile duct during LLLS.
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Affiliation(s)
- Hongyu Li
- Department of Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Lin Wei
- Department of Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Mingyue Zhu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhigui Zeng
- Department of Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Wei Qu
- Department of Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhijun Zhu
- Department of Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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17
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Hackl F, Nazemian R, Saeed A, Cheah YL, Kaufman MD. Anesthesia and Enhanced Recovery for Robotic Living Donor Hepatectomy – A Narrative Review. JOURNAL OF LIVER TRANSPLANTATION 2023. [DOI: 10.1016/j.liver.2023.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
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18
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Penninti P, Guerrero J. Living donor liver transplant: A strategy to increase transplant access. Clin Liver Dis (Hoboken) 2023; 21:89-91. [PMID: 37095777 PMCID: PMC10121436 DOI: 10.1097/cld.0000000000000022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/23/2022] [Indexed: 04/26/2023] Open
Affiliation(s)
- Pranav Penninti
- University of Texas Health Science Center at San Antonio, Gastroenterology, Texas, USA
| | - Juan Guerrero
- UT Health San Antonio, Transplant Center, San Antonio, Texas, USA
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19
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Incidental Detection of Neurovasular Bundle Compression by Dampening of Radial Artery Waveform in Pediatric Live Donor Liver Transplantation. JOURNAL OF LIVER TRANSPLANTATION 2023. [DOI: 10.1016/j.liver.2023.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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20
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Fujiki M, Hashimoto K, Quintini C, Aucejo F, Kwon CHD, Matsushima H, Sasaki K, Campos L, Eghtesad B, Diago T, Iuppa G, D'amico G, Kumar S, Liu P, Miller C, Pinna A. Living Donor Liver Transplantation With Augmented Venous Outflow and Splenectomy: A Promised Land for Small Left Lobe Grafts. Ann Surg 2022; 276:838-845. [PMID: 35894443 DOI: 10.1097/sla.0000000000005630] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Living donor liver transplantation (LDLT) using small grafts, especially left lobe grafts (H1234-MHV) (LLG), continues to be a challenge due to small-for-size syndrome (SFSS). We herein demonstrate that with surgical modifications, outcomes with small grafts can be improved. METHODS Between 2012 and 2020, we performed 130 adult LDLT using 61 (47%) LLG (H1234-MHV) in a single Enterprise. The median graft-to-recipient weight ratio was 0.84%, with graft-to-recipient weight ratio <0.7% accounting for 22%. Splenectomy was performed in 72 (56%) patients for inflow modulation before (n=50) or after (n=22) graft reperfusion. In LLG-LDLT, venous outflow was achieved using all three recipient hepatic veins. In right lobe graft (H5678) (RLG)-LDLT, the augmented graft right hepatic vein was anastomosed to the recipient's cava with a large cavotomy. Outcome measures include SFSS, early allograft dysfunction (EAD), and survival. RESULTS Graft survival rates at 1, 3, and 5 years were 94%, 90%, and 83%, respectively, with no differences between LLG (H1234-MHV) and RLG (H5678). Splenectomy significantly reduced portal flow without increasing the complication rate. Despite the aggressive use of small grafts, SFSS and EAD developed in only 1 (0.8%) and 18 (13.8%) patients, respectively. Multivariable logistic regression revealed model for end-stage liver disease score and LLG (H1234-MHV) as independent risk factors for EAD and splenectomy as a protective factor (odds ratio: 0.09; P =0.03). For LLG (H1234-MHV)-LDLT, patients who underwent prereperfusion splenectomy tended to have better 1-year graft survival than those receiving postreperfusion splenectomy. CONCLUSIONS LLG (H1234-MHV) are feasible in adult LDLT with excellent outcomes comparable to RLG (H5678). Venous outflow augmentation and splenectomy help lower the threshold of using small-for-size grafts without compromising graft survival.
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Affiliation(s)
| | | | | | | | | | | | | | - Luis Campos
- Transplant Center, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Teresa Diago
- Transplant Center, Cleveland Clinic, Cleveland, OH
| | - Giuseppe Iuppa
- Transplant Center, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Shiva Kumar
- Transplant Center, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Peter Liu
- Department of Radiology, Cleveland Clinic, Cleveland, OH
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21
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Rammohan A, Rela M, Kim DS, Soejima Y, Kasahara M, Ikegami T, Spiro M, Aristotle Raptis D, Humar A. Does modification of portal pressure and flow enhance recovery of the recipient after living donor liver transplantation? A systematic review of literature and expert panel recommendations. Clin Transplant 2022; 36:e14657. [PMID: 35344628 DOI: 10.1111/ctr.14657] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/11/2022] [Accepted: 03/25/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Portal inflow modulation (PIM) aimed at reducing portal hyperperfusion is commonly used in living donor liver transplantation (LDLT) to reduce the risk of small-for-size syndrome (SFSS). Many different techniques, both pharmacological and surgical have been used for this purpose. There is, however, little consensus on the best method of PIM, its exact role in preventing SFSS and on early post-LDLT recovery. OBJECTIVES To identify whether modifications of portal pressures and flows enhance recovery after LDLT and to provide international expert panel recommendations. DATA SOURCES Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. METHODS Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. PROSPERO ID CRD42021260997. RESULTS Five hundred and ninety four articles were identified through databases' search. Of the 24 included for a final review by the working group (WG), there were five randomized control trials, four prospective studies and 15 retrospective series. Six outcome measures which were likely to influence early recovery after LDLT, especially in small-for-size grafts (SFSG) were shortlisted. These included acute kidney injury, SFSS, morbidity including sepsis, length of ICU and hospital stay, morbidity of the PIM technique and overall mortality. The WG noted that PIM in this subset of LDLT recipients had a beneficial effect on all the outcomes measures. CONCLUSIONS Considering all decision domains, the panel recommends pre- and intraoperative actual graft weight validation, portal pressure/flow measurements, and a comprehensive donor evaluation for the determination of potentially small-for-size/ small-for-flow grafts as mandatory. (Quality of Evidence: Moderate | Grade of Recommendation: Strong) Pharmacological PIM helps improve early renal function in LDLT recipients. (Quality of Evidence: High | Grade of Recommendation: Strong) In selected patients with SFSG, PIM helps reduce SFSS/EAD and sepsis. (Quality of Evidence: Moderate | Grade of Recommendation: Strong) PIM in the form of splenectomy has increased morbidity compared to splenic artery ligation (SAL). (Quality of Evidence: Low | Grade of Recommendation: Strong) In LDLT recipients with SFSG, PIM may help reduce morbidity/mortality. (Quality of Evidence: Low | Grade of Recommendation: Strong) In LDLT recipients with SFSG, modification of portal pressures and flows enhances recovery after LDLT. (Quality of Evidence: Moderate | Grade of Recommendation: Strong).
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Affiliation(s)
- Ashwin Rammohan
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India
| | - Mohamed Rela
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India
| | - Dong-Sik Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yuji Soejima
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Toru Ikegami
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Michael Spiro
- Department of Anesthesia and Intensive Care Medicine, Royal Free Hospital, London, UK.,Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Dimitri Aristotle Raptis
- Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Abhinav Humar
- Thomas E. Starzl Transplantation Institute (STI), University of Pittsburgh Medical Center, Pittsburgh, USA
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22
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Abdel-Khalek EE, Abdel-Wahab M, Elgazzar MH, Khattab MA, El-Gilany AH, Elgouhari HM, Shehta A. Long-term follow-up of living liver donors: A single-center experience. Liver Transpl 2022; 28:1490-1499. [PMID: 35289076 DOI: 10.1002/lt.26455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 01/13/2023]
Abstract
Living donors are healthy individuals who are exposed to a major surgical procedure during which a major part of their liver is resected. Data on the long-term consequences of living liver donation are scarce. This study examined clinical, laboratory, and long-term health-related quality of life (HRQoL) in 237 living liver donors and 239 matched controls during 48-168 months of postdonation follow-up. We used the 36-item short-form health survey (SF-36), version 1. The scores for the four following subscales were higher in nondonors than in donors: physical functioning (p = 0.009), role limitations due to physical health (p = 0.002), energy/fatigue (p < 0.001), and bodily pain (p < 0.001). The scores on the eight subscales of the SF-36 were higher in donors with living recipients than in donors whose recipients died (p < 0.001). Our results suggest that living donor right hepatectomy is safe and results in a postdonation HRQoL similar to that of nondonors in those donors whose recipients are healthy, whereas donors whose recipients die have a lower HRQoL that is significantly negatively correlated with the time since recipient death and improves over time.
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Affiliation(s)
- Ehab E Abdel-Khalek
- Liver Transplant Unit, Department of Internal Medicine, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Mohamed Abdel-Wahab
- Liver Transplant Unit, Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Mohamed H Elgazzar
- Liver Transplant Unit, Department of Internal Medicine, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Mahmoud A Khattab
- Department of Internal Medicine, Faculty of Medicine, University of Minia, Minia, Egypt
| | - Abdel-Hady El-Gilany
- Department of Public Health, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | | | - Ahmed Shehta
- Liver Transplant Unit, Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
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23
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Jackson WE, Malamon JS, Kaplan B, Saben JL, Schold JD, Pomposelli JJ, Pomfret EA. Survival Benefit of Living-Donor Liver Transplant. JAMA Surg 2022; 157:926-932. [PMID: 35921119 PMCID: PMC9350845 DOI: 10.1001/jamasurg.2022.3327] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Despite the acceptance of living-donor liver transplant (LDLT) as a lifesaving procedure for end-stage liver disease, it remains underused in the United States. Quantification of lifetime survival benefit and the Model for End-stage Liver Disease incorporating sodium levels (MELD-Na) score range at which benefit outweighs risk in LDLT is necessary to demonstrate its safety and effectiveness. Objective To assess the survival benefit, life-years saved, and the MELD-Na score at which that survival benefit was obtained for individuals who received an LDLT compared with that for individuals who remained on the wait list. Design, Setting, and Participants This case-control study was a retrospective, secondary analysis of the Scientific Registry of Transplant Recipients database of 119 275 US liver transplant candidates and recipients from January 1, 2012, to September 2, 2021. Liver transplant candidates aged 18 years or older who were assigned to the wait list (N = 116 455) or received LDLT (N = 2820) were included. Patients listed for retransplant or multiorgan transplant and those with prior kidney or liver transplants were excluded. Exposures Living-donor liver transplant vs remaining on the wait list. Main Outcomes and Measures The primary outcome of this study was life-years saved from receiving an LDLT. Secondary outcomes included 1-year relative mortality and risk, time to equal risk, time to equal survival, and the MELD-Na score at which that survival benefit was obtained for individuals who received an LDLT compared with that for individuals who remained on the wait list. MELD-Na score ranges from 6 to 40 and is well correlated with short-term survival. Higher MELD-Na scores (>20) are associated with an increased risk of death. Results The mean (SD) age of the 119 275 study participants was 55.1 (11.2) years, 63% were male, 0.9% were American Indian or Alaska Native, 4.3% were Asian, 8.2% were Black or African American, 15.8% were Hispanic or Latino, 0.2% were Native Hawaiian or Other Pacific Islander, and 70.2% were White. Mortality risk and survival models confirmed a significant survival benefit for patients receiving an LDLT who had a MELD-Na score of 11 or higher (adjusted hazard ratio, 0.64 [95% CI, 0.47-0.88]; P = .006). Living-donor liver transplant recipients gained an additional 13 to 17 life-years compared with patients who never received an LDLT. Conclusions and Relevance An LDLT is associated with a substantial survival benefit to patients with end-stage liver disease even at MELD-Na scores as low as 11. The findings of this study suggest that the life-years gained are comparable to or greater than those conferred by any other lifesaving procedure or by a deceased-donor liver transplant. This study's findings challenge current perceptions regarding when LDLT survival benefit occurs.
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Affiliation(s)
- Whitney E Jackson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora.,Colorado Center for Transplantation Care, Research, and Education, University of Colorado Anschutz Medical Campus, Aurora
| | - John S Malamon
- Colorado Center for Transplantation Care, Research, and Education, University of Colorado Anschutz Medical Campus, Aurora.,Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Bruce Kaplan
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora.,Colorado Center for Transplantation Care, Research, and Education, University of Colorado Anschutz Medical Campus, Aurora.,Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Jessica L Saben
- Colorado Center for Transplantation Care, Research, and Education, University of Colorado Anschutz Medical Campus, Aurora.,Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Jesse D Schold
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - James J Pomposelli
- Colorado Center for Transplantation Care, Research, and Education, University of Colorado Anschutz Medical Campus, Aurora.,Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Elizabeth A Pomfret
- Colorado Center for Transplantation Care, Research, and Education, University of Colorado Anschutz Medical Campus, Aurora.,Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora
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24
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Amma BSPT, Mathew JS, Varghese CT, Nair K, Mallick S, Mrcs BC, Menon RN, Gopalakrishnan U, Balakrishnan D, George PS, Vayoth SO, Sudhindran S. OPEN TO ROBOTIC RIGHT DONOR HEPATECTOMY: A TECTONIC SHIFT IN SURGICAL TECHNIQUE. Clin Transplant 2022; 36:e14775. [PMID: 35876772 DOI: 10.1111/ctr.14775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/10/2022] [Indexed: 11/28/2022]
Abstract
Robotic right live donor hepatectomy(r-LDRH) has been reported with reduced morbidity compared to open donor right hepatectomy(o-LDRH) in few recent series. Nevertheless, its routine use is debated. We present a large series comparing pure r-LDRH with o-LDRH. Consecutive r-LDRH performed from June 2018 to June 2020 (n = 102) were compared with consecutive donors undergoing o-LDRH (n = 152) from February 2016 to February 2018, a period when r-LDRH was not available at this centre. Propensity score matched (PSM) analysis of 89 case-control pairs was additionally performed. Primary endpoints were length of high dependency unit (HDU) & hospital stay and Clavien-Dindo graded complications among donors. Although r-LDRH took longer to perform (540 versus 462 mins, P<0.001), the post-operative peak transaminases levels(P<0.001), the length of HDU (3 versus 4 days, P<0.001) and hospital stay (8 versus 9 days, P<0.001) were lower in in donors undergoing r-LDRH. Clavien-Dindo graded complications were similar (16.67% in r-LDRH and 13.16% in o-LDRH). The rates of early allograft dysfunction (1.6% versus 3.3%), bile leak (14.7% versus 10.7%), and 1-year mortality (13.7% versus 11.8%) were comparable between r-LDRH and o-LDRH recipients. PSM analysis yielded similar results between the groups. These data support the safety and feasibility of r-LDRH in select donors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Binoj Sivasankara Pillai Thankamony Amma
- Department of Gastrointestinal Surgery & Solid Organ Transplant, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi, Kerala, 682041, India
| | - Johns Shaji Mathew
- Department of Gastrointestinal Surgery & Solid Organ Transplant, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi, Kerala, 682041, India
| | - Christi Titus Varghese
- Department of Gastrointestinal Surgery & Solid Organ Transplant, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi, Kerala, 682041, India
| | - Krishnanunni Nair
- Department of Gastrointestinal Surgery & Solid Organ Transplant, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi, Kerala, 682041, India
| | - Shweta Mallick
- Department of Gastrointestinal Surgery & Solid Organ Transplant, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi, Kerala, 682041, India
| | - Biju Chandran Mrcs
- Department of Gastrointestinal Surgery & Solid Organ Transplant, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi, Kerala, 682041, India
| | - Ramachandran Narayana Menon
- Department of Gastrointestinal Surgery & Solid Organ Transplant, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi, Kerala, 682041, India
| | - Unnikrishnan Gopalakrishnan
- Department of Gastrointestinal Surgery & Solid Organ Transplant, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi, Kerala, 682041, India
| | - Dinesh Balakrishnan
- Department of Gastrointestinal Surgery & Solid Organ Transplant, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi, Kerala, 682041, India
| | - Preethi Sara George
- Department of Biostatistics, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Sudheer Othiyil Vayoth
- Department of Gastrointestinal Surgery & Solid Organ Transplant, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi, Kerala, 682041, India
| | - Surendran Sudhindran
- Department of Gastrointestinal Surgery & Solid Organ Transplant, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi, Kerala, 682041, India
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25
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Al Harakeh H, Emmanuel B, Hughes C, Tevar A, Steel JL, DiMartini A, Ganesh S, Sood P, Humar A. Sequential liver and kidney living donors: Making the ultimate gift twice. Clin Transplant 2022; 36:e14750. [PMID: 35695890 DOI: 10.1111/ctr.14750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/01/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
There are nearly 150 living donors in the United States who donated more than one solid organ. Using our divisional database, we found 20 individuals who donated a liver and a kidney at different times. We performed a retrospective chart review of these donors, studying their motivating factors, complications and outcomes. The donors included 11 (55%) males and nine females. Thirteen (65%) donated the kidney before the liver. Fourteen (70%) were nondirected donors at the first donation, and four of the six directed donors in the first donation became nondirected in the second donation. Seventeen (85%) were nondirected at the second donation. Common reasons for donating the second time were a good experience with the first donation and knowing that one can donate again. Outcomes and the incidence of early complications were not significantly different after the 2nd versus the 1st donation. All donors recovered and currently are doing well. Our results show a significant number of dual organ donors are nondirected and motivated by their strong desire to help. A positive experience with the 1st donation often was the driving factor for the 2nd. A history of previous organ donation did not negatively impact the 2nd donation.
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Affiliation(s)
- Hasan Al Harakeh
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bishoy Emmanuel
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Amit Tevar
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Andrea DiMartini
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Swaytha Ganesh
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Puneet Sood
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Abhinav Humar
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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26
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Emamaullee J, Heimbach JK, Olthoff KM, Pomfret EA, Roberts JP, Selzner N. Assessment of long-term outcomes post living liver donation highlights the importance of scientific integrity when presenting transplant registry data. Am J Transplant 2022; 22:1519-1522. [PMID: 35352461 PMCID: PMC9177716 DOI: 10.1111/ajt.17045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/14/2022] [Accepted: 03/26/2022] [Indexed: 01/25/2023]
Abstract
Living donor liver transplantation has expanded in recent years, particularly in North America. As experience with this procedure has matured over the last 25 years, centers are increasingly faced with potential living donors who are more medically complex. As donors move through the evaluation process, completing the informed consent process continues to be challenged by a paucity of granular data demonstrating long-term outcomes and overall safety specifically in the otherwise "healthy" living liver donor population. Two recently published studies examined long-term outcomes post-living liver donation using Korean registry data and reported similar results, with excellent overall survival when compared to appropriately matched controls. However, the authors of these studies were presented differently, with one reporting an alarmist view based on one aspect of a suboptimal analysis approach using an inappropriate comparator group. Herein, the North American Living Liver Donor Innovation Group (NALLDIG) consortium discusses these two studies and their potential impact on living liver donation in North America, ultimately highlighting the importance of scientific integrity in data presentation and dissemination when using transplant registry data.
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Affiliation(s)
- Juliet Emamaullee
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA,Department of SurgeryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Kim M. Olthoff
- Department of SurgeryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Elizabeth A. Pomfret
- Department of SurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - John P. Roberts
- Department of SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Nazia Selzner
- Department of MedicineAjmera Transplant CenterUniversity of TorontoTorontoOntarioCanada
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27
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Lincango Naranjo EP, Garces-Delgado E, Siepmann T, Mirow L, Solis-Pazmino P, Alexander-Leon H, Restrepo-Rodas G, Mancero-Montalvo R, Ponce CJ, Cadena-Semanate R, Vargas-Cordova R, Herrera-Cevallos G, Vallejo S, Liu-Sanchez C, Prokop LJ, Ziogas IA, Vailas MG, Guerron AD, Visser BC, Ponce OJ, Barbas AS, Moris D. Robotic Living Donor Right Hepatectomy: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11092603. [PMID: 35566727 PMCID: PMC9103024 DOI: 10.3390/jcm11092603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 12/10/2022] Open
Abstract
The introduction of robotics in living donor liver transplantation has been revolutionary. We aimed to examine the safety of robotic living donor right hepatectomy (RLDRH) compared to open (ODRH) and laparoscopic (LADRH) approaches. A systematic review was carried out in Medline and six additional databases following PRISMA guidelines. Data on morbidity, postoperative liver function, and pain in donors and recipients were extracted from studies comparing RLDRH, ODRH, and LADRH published up to September 2020; PROSPERO (CRD42020214313). Dichotomous variables were pooled as risk ratios and continuous variables as weighted mean differences. Four studies with a total of 517 patients were included. In living donors, the postoperative total bilirubin level (MD: −0.7 95%CI −1.0, −0.4), length of hospital stay (MD: −0.8 95%CI −1.4, −0.3), Clavien−Dindo complications I−II (RR: 0.5 95%CI 0.2, 0.9), and pain score at day > 3 (MD: −0.6 95%CI −1.6, 0.4) were lower following RLDRH compared to ODRH. Furthermore, the pain score at day > 3 (MD: −0.4 95%CI −0.8, −0.09) was lower after RLDRH when compared to LADRH. In recipients, the postoperative AST level was lower (MD: −0.5 95%CI −0.9, −0.1) following RLDRH compared to ODRH. Moreover, the length of stay (MD: −6.4 95%CI −11.3, −1.5) was lower after RLDRH when compared to LADRH. In summary, we identified low- to unclear-quality evidence that RLDRH seems to be safe and feasible for adult living donor liver transplantation compared to the conventional approaches. No postoperative deaths were reported.
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Affiliation(s)
- Eddy P. Lincango Naranjo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA; (E.P.L.N.); (S.V.); (O.J.P.)
- Department of Teaching and Research, Hospital Vozandes Quito, Quito 170521, Ecuador
- Equipo de Investigación de la Sociedad Ecuatoriana de Cirugía Bariátrica y Metabólica (SECBAMET), Quito 170508, Ecuador; (E.G.-D.); (H.A.-L.); (G.R.-R.); (R.M.-M.); (C.J.P.); (R.C.-S.); (R.V.-C.); (G.H.-C.)
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, 01067 Dresden, Germany;
| | - Estefany Garces-Delgado
- Equipo de Investigación de la Sociedad Ecuatoriana de Cirugía Bariátrica y Metabólica (SECBAMET), Quito 170508, Ecuador; (E.G.-D.); (H.A.-L.); (G.R.-R.); (R.M.-M.); (C.J.P.); (R.C.-S.); (R.V.-C.); (G.H.-C.)
- Medical School, Universidad Internacional del Ecuador, Quito 170411, Ecuador
| | - Timo Siepmann
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, 01067 Dresden, Germany;
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Lutz Mirow
- Department of General and Visceral Surgery, Medical Campus Chemnitz of the TU Dresden, 01307 Dresden, Germany;
| | - Paola Solis-Pazmino
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Harold Alexander-Leon
- Equipo de Investigación de la Sociedad Ecuatoriana de Cirugía Bariátrica y Metabólica (SECBAMET), Quito 170508, Ecuador; (E.G.-D.); (H.A.-L.); (G.R.-R.); (R.M.-M.); (C.J.P.); (R.C.-S.); (R.V.-C.); (G.H.-C.)
- Medical School, Universidad de las Américas, Quito 170503, Ecuador
| | - Gabriela Restrepo-Rodas
- Equipo de Investigación de la Sociedad Ecuatoriana de Cirugía Bariátrica y Metabólica (SECBAMET), Quito 170508, Ecuador; (E.G.-D.); (H.A.-L.); (G.R.-R.); (R.M.-M.); (C.J.P.); (R.C.-S.); (R.V.-C.); (G.H.-C.)
- Medical School, Universidad Internacional del Ecuador, Quito 170411, Ecuador
| | - Rafael Mancero-Montalvo
- Equipo de Investigación de la Sociedad Ecuatoriana de Cirugía Bariátrica y Metabólica (SECBAMET), Quito 170508, Ecuador; (E.G.-D.); (H.A.-L.); (G.R.-R.); (R.M.-M.); (C.J.P.); (R.C.-S.); (R.V.-C.); (G.H.-C.)
- Medical School, Universidad Internacional del Ecuador, Quito 170411, Ecuador
| | - Cristina J. Ponce
- Equipo de Investigación de la Sociedad Ecuatoriana de Cirugía Bariátrica y Metabólica (SECBAMET), Quito 170508, Ecuador; (E.G.-D.); (H.A.-L.); (G.R.-R.); (R.M.-M.); (C.J.P.); (R.C.-S.); (R.V.-C.); (G.H.-C.)
- Medical School, Universidad Internacional del Ecuador, Quito 170411, Ecuador
| | - Ramiro Cadena-Semanate
- Equipo de Investigación de la Sociedad Ecuatoriana de Cirugía Bariátrica y Metabólica (SECBAMET), Quito 170508, Ecuador; (E.G.-D.); (H.A.-L.); (G.R.-R.); (R.M.-M.); (C.J.P.); (R.C.-S.); (R.V.-C.); (G.H.-C.)
- Medical School, Universidad Internacional del Ecuador, Quito 170411, Ecuador
| | - Ronnal Vargas-Cordova
- Equipo de Investigación de la Sociedad Ecuatoriana de Cirugía Bariátrica y Metabólica (SECBAMET), Quito 170508, Ecuador; (E.G.-D.); (H.A.-L.); (G.R.-R.); (R.M.-M.); (C.J.P.); (R.C.-S.); (R.V.-C.); (G.H.-C.)
- Division of Metabolic and Weight Loss Surgery, Hospital General San Francisco IESS, Quito 170111, Ecuador
| | - Glenda Herrera-Cevallos
- Equipo de Investigación de la Sociedad Ecuatoriana de Cirugía Bariátrica y Metabólica (SECBAMET), Quito 170508, Ecuador; (E.G.-D.); (H.A.-L.); (G.R.-R.); (R.M.-M.); (C.J.P.); (R.C.-S.); (R.V.-C.); (G.H.-C.)
- Division of Metabolic and Weight Loss Surgery, Hospital Metropolitano, Quito 170521, Ecuador
| | - Sebastian Vallejo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA; (E.P.L.N.); (S.V.); (O.J.P.)
| | - Carolina Liu-Sanchez
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru;
| | - Larry J. Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN 55905, USA;
| | - Ioannis A. Ziogas
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Michail G. Vailas
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Alfredo D. Guerron
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC 27705, USA;
| | - Brendan C. Visser
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Stanford University, Stanford, CA 94305, USA;
| | - Oscar J. Ponce
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA; (E.P.L.N.); (S.V.); (O.J.P.)
- Frimley Park Hospital, Frimley Health NHS Foundation Trust, Surrey GU16 7UJ, UK
| | | | - Dimitrios Moris
- Department of Surgery, Duke University, Durham, NC 27705, USA;
- Correspondence:
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28
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Liver Transplantation in Singapore: Challenges and Strategies of Low- to Mid-volume Centers. Transplantation 2022; 106:895-897. [PMID: 35470351 DOI: 10.1097/tp.0000000000003925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Han DH. Current status of robotic surgery for liver transplantation. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dai Hoon Han
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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30
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Sakai T, Ko JS, Crouch CE, Kumar S, Choi GS, Hackl F, Han DH, Kaufman M, Kim SH, Luzzi C, McCluskey S, Shin WJ, Sirianni J, Song KW, Sullivan C, Hendrickse A. Perioperative management of living donor liver transplantation: Part 2 - Donors. Clin Transplant 2022; 36:e14690. [PMID: 35477939 DOI: 10.1111/ctr.14690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/26/2022] [Accepted: 04/23/2022] [Indexed: 01/10/2023]
Abstract
Living donor liver transplantation was first developed to mitigate the limited access to deceased donor organs in Asia in the 1990s. This alternative liver transplantation method has become a widely practiced and established transplantation option for adult patients suffering with end-stage liver disease, and it has successfully helped address the shortage of deceased donors. The Society for the Advancement of Transplant Anesthesia and the Korean Society of Transplantation Anesthesiologists jointly reviewed published studies on the perioperative management of adult live liver donors undergoing donor hemi-hepatectomy. The goal of the review is to offer transplant anesthesiologists and critical care physicians a comprehensive overview of the perioperative management of adult live donors. We featured the current status, donor selection process, outcomes and complications, surgical procedure, anesthetic management, Enhanced Recovery After Surgery protocols, avoidance of blood transfusion, and considerations for emergency donation. Recent surgical advances, including laparoscopic donor hemi-hepatectomy and robotic laparoscopic donor surgery, are also addressed.
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Affiliation(s)
- Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pennsylvania, USA
| | - Justin Sangwook Ko
- Department of Anesthesiology & Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cara E Crouch
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sathish Kumar
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Florian Hackl
- Department of Anesthesiology and Interventional Pain Management, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Dai Hoon Han
- Department of HBP Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Michael Kaufman
- Department of Anesthesiology and Interventional Pain Management, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Seong Hoon Kim
- Organ Transplantation Center, National Cancer Center, Gyeonggi-do, Republic of Korea
| | - Carla Luzzi
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stuart McCluskey
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Won Jung Shin
- Department of Anesthesiology & Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joel Sirianni
- Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ki Won Song
- Department of Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Cinnamon Sullivan
- Department of Anesthesiology, Emory University, Atlanta, Georgia, USA
| | - Adrian Hendrickse
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Varghese CT, Chandran B, Gopalakrishnan U, Nair K, Mallick S, Mathew JS, Sivasankara Pillai Thankamony Amma B, Balakrishnan D, Sudheer OV, Sudhindran S. Extended criteria donors for Robotic Right Hepatectomy- A Propensity Score matched Analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:874-883. [PMID: 35411725 DOI: 10.1002/jhbp.1145] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Robotic right donor hepatectomy (RDH) has been reported from experienced centers with reduced morbidity when compared to open RDH. However, outcomes in donors with large grafts/ complex biliovascular anatomy are unknown. METHODS Out of 170 robotic RDH, 100 had one or more of the following: graft weight ≥ 800gms, type 2/3 portal vein, >1 bile duct or hepatic artery and inferior hepatic veins >5mm requiring reconstruction (extended criteria donors- ExRDH), while the remaining 70 had standard anatomy (SRDH). After propensity score matching, 66 ExRDH were compared with 66 SRDH. Additionally, all robotic RDH performed were analysed in 3 temporal phases (60, 60 and 50). RESULTS Peak AST and ALT were higher among donors and recipients in the ExRDH arm compared to SRDH. Other intraoperative parameters and post-operative complications were similar between the two groups. During the last phase, donors demonstrated reduction in duration of surgery, postoperative complications and hospital stay while recipients showed decreased blood loss and hospital stay. CONCLUSION Robotic right hepatectomy performed in donors with extended criteria have similar perioperative outcomes as standard donors. However, a significant learning curve needs to be traversed. Further studies are required before safely recommending robotic RDH for all donors.
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Affiliation(s)
- Christi Titus Varghese
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - Biju Chandran
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - Unnikrishnan Gopalakrishnan
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - Krishnanunni Nair
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - Shweta Mallick
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - Johns Shaji Mathew
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | | | - Dinesh Balakrishnan
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - O V Sudheer
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - S Sudhindran
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
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32
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Choi JY, Kim JH, Kim JM, Kim HJ, Ahn HS, Joh JW. Outcomes of living liver donors are worse than those of matched healthy controls. J Hepatol 2022; 76:628-638. [PMID: 34785324 DOI: 10.1016/j.jhep.2021.10.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Donor death is the most serious complication of living liver donation but is reported rarely. We investigated the actual mortality of living liver donors (LLDs) compared with matched control groups based on analysis of the Korean National Health Insurance Services (NHIS) database. METHODS This cohort study included 12,372 LLDs who donated a liver graft between 2002 and 2018, and were registered in the Korean Network for Organ Sharing. They were compared to 3 matched control groups selected from the Korean NHIS and comprising a total of 123,710 individuals: healthy population (Group I); general population without comorbidities (Group II); and general population with comorbidities (Group III). RESULTS In this population, 78.5% of living liver donors were 20-39 years old, and 64.7% of all donors were male. Eighty-nine donors (0.7%) in the LLD group died (68 males and 21 females), a mortality rate (/1,000 person-years) of 0.91 (0.74-1.12). Mortality rate ratio and the adjusted hazard ratio of the LLD group was 2.03 (1.61-2.55) and 1.71 (1.31-2.25) compared to Control Group I, 0.75 (0.60-0.93) and 0.63 (0.49-0.82) compared to Control Group II, and 0.58 (0.46-0.71) and 0.49 (0.39-0.60) compared to Control Group III. LLD group, depression, and lower income were risk factors for adjusted mortality. The incidence of liver failure, depression, cancer, diabetes, hypertension, brain infarction, brain hemorrhage, and end-stage renal disease in the LLD group was significantly higher than in Control Group I. CONCLUSIONS Outcomes of the LLD group were worse than those of the matched healthy control group despite the small number of deaths and medical morbidities in this group. LLDs should receive careful medical attention for an extended period after donation. LAY SUMMARY The incidence of mortality, liver failure, depression, cancer, diabetes, hypertension, brain infarction, brain hemorrhage, and end-stage renal disease in the living liver donor group was significantly higher than in the matched healthy group. Careful donor evaluation and selection processes can improve donor safety and enable safe living donor liver transplantation.
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Affiliation(s)
- Jin Yong Choi
- Department of General Surgery, Myongji Hospital, Goyang, South Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University, Seoul, South Korea.
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University, Seoul, South Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Papoulas M, Hakeem AR, Heaton N, Menon KV. Pure laparoscopic versus open donor hepatectomy for adult living donor liver transplantation - A systematic review and meta-analysis. J Minim Access Surg 2022; 18:1-11. [PMID: 35017391 PMCID: PMC8830577 DOI: 10.4103/jmas.jmas_103_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Pure laparoscopic donor hepatectomy (PLDH) for adult living donor liver transplantation (LDLT) remains controversial. The aim of this study was to undertake a systematic review and meta-analysis of donor outcomes following PLDH for adult LDLT. Materials and Methods Systematic review in line with the meta-analysis of observational studies in epidemiology guidelines. Results Eight studies were included in the systematic review and six in the meta-analysis. A total of 575 donors underwent PLDH for adult LDLT. The mean donor age was 32.8 years with a BMI of 23.4 kg/m2 and graft weight of 675 g. The mean operative time was 353 min and the conversion rate was 2.8% (n = 16). Overall morbidity was 10.8% with 1.6% major complications (Clavien-Dindo grade 3b), zero mortality and 9.0 days length of stay (LOS). The meta-analysis demonstrated that the operative time was significantly shorter for the open donor hepatectomy group (mean difference 29.15 min; P = 0.006) and the LOS was shorter for the PLDH group (mean difference -0.73 days; P = 0.02), with a trend towards lesser estimated blood loss in PLDH group. However, no difference between the two groups was noted in terms of overall morbidity or major complications. Conclusions Perioperative outcomes of PLDH are similar to the standard open approach in highly specialised centers with trend towards lesser blood loss and overall shorter hospital stay. Careful donor selection and standardisation of the technique are imperative for the successful implementation and adoption of the procedure worldwide.
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Affiliation(s)
- Michail Papoulas
- Department of Institute of Liver Studies, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, UK
| | - Abdul Rahman Hakeem
- Department of Hepatobiliary and Liver Transplantation, St. James's University Hospital NHS Trust, Leeds, UK
| | - Nigel Heaton
- Department of Institute of Liver Studies, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, UK
| | - Krishna V Menon
- Department of Institute of Liver Studies, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, UK
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Pei J, Shen C, Li R, Tao Y, Lu L, Chen W, Xie X, Wang Z. Comparison of Two Donor Liver Procurement Methods for Treatment of Pediatric Acute Liver Failure. Front Pediatr 2022; 10:816516. [PMID: 35311062 PMCID: PMC8927919 DOI: 10.3389/fped.2022.816516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/25/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND To evaluate the difference and efficacy of two donor liver procurement methods for treatment of pediatric acute liver failure (PALF) by living donor liver transplantation (LDLT). METHODS A total of 17 patients (12 men, 5 women) with PALF who underwent LDLT in our hospital between October 2016 and October 2020, and prognostic efficacy of donors and recipients using two donor liver procurement methods were analyzed. RESULTS The donors and recipients were both divided into laparoscopic (7 cases) and open (10 cases) donor liver procurement groups. In the recipients, two deaths occurred in the laparoscopic group and one in the open group, and there were three postoperative complications in the laparoscopic group and six in the open group. The cumulative 1-year and 3-year survival rates in the laparoscopic group and the open group were 80.0% and 85.7% separately. There was no difference in the postoperative survival and complications rates between the two groups. In the donors, the operation time, postoperative hospital stay, and blood loss of the laparoscopic group was significantly reduced compared with the open group (P ≤ 0.01). No death or serious complication occurred in either donor group. CONCLUSION Laparoscopic donor liver procurement is worth recommending than open donor liver procurement for treatment of PALF combined with LDLT in qualified transplant centers.
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Affiliation(s)
- Jiahao Pei
- Department of General Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Conghuan Shen
- Department of General Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Ruidong Li
- Department of General Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Yifeng Tao
- Department of General Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Lu Lu
- Department of General Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Weiming Chen
- Department of Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Xinbao Xie
- Department of Liver Disease, Children's Hospital of Fudan University, Shanghai, China
| | - Zhengxin Wang
- Department of General Surgery, Huashan Hospital of Fudan University, Shanghai, China
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Broering D, Sturdevant ML, Zidan A. Robotic donor hepatectomy: A major breakthrough in living donor liver transplantation. Am J Transplant 2022; 22:14-23. [PMID: 34783439 DOI: 10.1111/ajt.16889] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 02/06/2023]
Abstract
Living donation in many countries is the main resource of organs. Healthy, volunteering individuals deserve the highest safety standards possible in addition to the least invasive technique to procure the organs. Since the introduction of living donor liver transplantation, many efforts have been made to minimize the surgical trauma inherent to living donor surgery. The journey started with a large Mercedes incision and evolved to reverse L-shaped and small upper midline incisions before the introduction of minimally invasive laparoscopic techniques originated. The technical difficulties of the laparoscopic approach due to suboptimal instrumentation, challenging ergonomics, and the long learning curve limited the application of the fully laparoscopic approach to a few centers. The recent introduction of the robotic platform with its superb optical system and advanced instruments allows for the first time, a genuine emulation of open donor surgery in a closed abdomen, thus allowing all liver donors to benefit from minimally invasive surgery (better cosmesis, less pain and morbidity, and better quality of life) without compromising donor safety. This attribute in combination with the ubiquitous presence of the robot in major transplant centers may well lead to the desired endpoint of this technology, namely, the widespread dissemination of minimally invasive donor surgery.
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Affiliation(s)
- Dieter Broering
- Organ Transplant Center of Excellence - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mark L Sturdevant
- Organ Transplant Center of Excellence - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.,Department of Surgery, Division of Transplant - University of Washington Medical Center, Seattle, Washington
| | - Ahmed Zidan
- Organ Transplant Center of Excellence - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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He K, Pan Y, Wang H, Zhu J, Qiu B, Luo Y, Xia Q. Pure Laparoscopic Living Donor Hepatectomy With/Without Fluorescence-Assisted Technology and Conventional Open Procedure: A Retrospective Study in Mainland China. Front Surg 2021; 8:771250. [PMID: 34966776 PMCID: PMC8710496 DOI: 10.3389/fsurg.2021.771250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022] Open
Abstract
Background: The application of laparoscopy in donor liver acquisition for living donor liver transplantation (LDLT) has become increasingly popular in the past decade. Indole cyanide green (ICG) fluorescence technique is a new adjuvant method in surgery. The purpose was to compare the safety and efficacy of laparoscopic and open surgery in living donor left lateral hepatectomy, and to evaluate the application of ICG in laparoscopy. Methods: Donors received LDLT for left lateral lobe resection from November 2016 to November 2020 were selected and divided into pure laparoscopy donor hepatectomy (PLDH) group, fluorescence-assisted pure laparoscopy donor hepatectomy (FAPLDH) group and open donor hepatectomy (ODH) group. We compared perioperative data and prognosis of donors and recipients. Quality of life were evaluated by SF-36 questionnaires. Results: The operation time of PLDH group (169.29 ± 26.68 min) was longer than FAPLDH group (154.34 ± 18.40 min) and ODH group (146.08 ± 25.39 min, p = 0.001). The blood loss was minimum in FAPLDH group (39.48 ± 10.46 mL), compared with PLDH group (52.44 ± 18.44 mL) and ODH group (108.80 ± 36.82 mL, p=0.001). The post-operative hospital stay was longer in PLDH group (5.30 ± 0.98 days) than FAPLDH group (4.81 ± 1.03 days) and ODH group (4.64 ± 1.20 days; p = 0.001). Quality of life of donors undergoing laparoscopic surgery was better. Conclusion: Laparoscopic approaches for LDLT contribute to less blood loss, better cosmetic satisfaction. The fluorescence technique can further reduce bleeding and shorten operation time. In terms of quality of life, laparoscopic surgery is better than open surgery. Laparoscopy procedure for living-donor procurement with/without fluorescence-assist can be performed as safely as open surgery.
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Affiliation(s)
- Kang He
- Department of Liver Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixiao Pan
- Department of Liver Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai Wang
- Department of Liver Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianjun Zhu
- Department of Liver Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bijun Qiu
- Department of Liver Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Luo
- Department of Liver Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Peng Y, Li B, Xu H, Chen K, Wei Y, Liu F. Pure Laparoscopic Versus Open Approach for Living Donor Right Hepatectomy: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2021; 32:832-841. [PMID: 34842460 DOI: 10.1089/lap.2021.0583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Pure laparoscopic liver donor right hepatectomy (LLDRH) remains challenging, and its value is still unclear compared with open liver donor right hepatectomy (OLDRH). Objective: To provide comprehensive evidence about the safety and efficacy of LLDRH. Methods: The MEDLINE, Embase, Web of Science, and Cochrane Library electronic databases were searched from the date of inception to July 2021. A fixed-effects or random-effects model was used to analyze the pooled data by using Review Manager Version 5.3. Results: A total of 1940 patients from 6 studies were enrolled in this meta-analysis. For perioperative outcomes of donors, LLDRH had a longer operative time than OLDRH (weighted mean difference [WMD] = 29.75 [4.23-55.26] minutes, P = .02), but it had lower overall morbidity (odds ratio [OR] = 0.67 [0.45-0.99], P = .04), fewer pulmonary complications (OR = 0.47 [0.29-0.76], P = .002), and shorter hospital stays (WMD = -1, P < .001) than OLDRH. However, major complications, biliary complications, portal vein problems, and intra-abdominal bleeding were comparable between the 2 groups. With regard to the postoperative data of recipients, the risks of biliary problems, hepatic artery problems, portal vein problems, hepatic vein problems, and postoperative liver failure were similar between the 2 groups. Conclusions: LLDRH for living donors is safe and effective, and it offers superior perioperative outcomes to OLDRH.
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Affiliation(s)
- Yufu Peng
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, China
| | - Bo Li
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, China
| | - Hongwei Xu
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, China
| | - Kang Chen
- Department of Hepatobiliary and Pancreatic Surgery, People's Hospital of Xichang City, Xichang City, China
| | - Yonggang Wei
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, China
| | - Fei Liu
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, China
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Jalil S, Black SM, Washburn K, Rangwani N, Hinton A, Kelly SG, Conteh L, Hanje J, Michaels A, Mumtaz K. Trends and Health Care Outcomes Among Living Liver Donors: Are We Ready to Expand the Donor Pool With Living Liver Donations? Liver Transpl 2021; 27:1603-1612. [PMID: 34213813 DOI: 10.1002/lt.26223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022]
Abstract
We studied the trends and various outcomes, including the readmission rates, health care utilization, and complications among living liver donors (LLDs) in the United States. We queried the National Database for data from 2010 to 2017 for all LLDs. The primary outcomes were 30-day and 90-day readmission rates. The secondary outcomes included health care use (length of stay [LOS], cost of care), index admission, and calendar-year mortality. Logistic regression models were fit for various outcomes. A total of 1316 LLDs underwent hepatectomy during the study period. The median donor age was 35.0 years (interquartile range, 27.4-43.6), and donors were predominantly women (54.2%). The trend of LLD surgeries remained stable at large medical centers (85.3%). The 30-day and 90-day readmission rates were low at 5% and 5.9%, respectively. Older age (50 years and older; 8%; confidence interval [CI], 0.6%-15.9%; P = 0.03) and hepatectomy at small to medium-sized hospitals were associated with increased index LOS (13.4%; 95% CI, 3.1%-24.7%; P = 0.01). Moreover, older age of donor (-11.3%; 95% CI, -20.3% to -1.4%; P = 0.03), Elixhauser score ≥3 (17%; 95% CI, 1.2%-35.3%; P = 0.03), and Medicaid insurance (24.5%; 95% CI, 1.2%-53.1%; P = 0.04) were also associated with increased cost. The overall rate of any complications during index admission was 42.8%. Male sex (odds ratio [OR], 1.63; 95% CI, 1.19-2.23) was an independent predictor of post-LLD complications. There was no index admission or calendar-year mortality reported during the study period. This is the largest national report of LLDs to date, showing that the trend of LLD surgeries is stable in the United States. With established safety, fewer complications, and less health care utilization, LLDs can be a potential source of continuation of liver transplantation in the context of changing liver allocation policies in the United States.
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Affiliation(s)
- Sajid Jalil
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sylvester M Black
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ken Washburn
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Neil Rangwani
- Division of Hospital Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alice Hinton
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sean G Kelly
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Lanla Conteh
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - James Hanje
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Anthony Michaels
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Khalid Mumtaz
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
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Dos Santos JPF, Martins R, Lopes MF. Donor Surgical Morbidity in Pediatric Living-Donor Liver Transplant: A Portuguese Experience. Pediatr Gastroenterol Hepatol Nutr 2021; 24:528-534. [PMID: 34796097 PMCID: PMC8593358 DOI: 10.5223/pghn.2021.24.6.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Living-donor liver transplant emerged as an alternative treatment for end stage liver disease due to the lack of cadaveric organs availability that met the demand. In Portugal, pediatric living-donor liver transplant (P-LDLT) was initiated in 2001 in Portugal in order to compensate for the scarcity of cadaveric organs for such cases. The aim of this study was to retrospectively analyze the morbi-mortality of the 28 donors included in P-LDLT program performed at Coimbra's Pediatric Hospital (CHUC), a Portuguese reference center. METHODS We retrospectively collected pertinent donor data and stratified complications according to Clavien's scoring system. RESULTS In total, 28.6% (n=8) of the donors had surgical complications. According to Clavien-Dindo's classification, two donors had major complications (Clavien grade ≥3), four donors had grade 2 complications, and two donors had grade 1 complications. There were no P-LDLT-related mortalities in the present case series. The most common verified complications were biliary tract injuries and superficial incisional infections, which are consistent with the complications reported in worldwide series. CONCLUSION These patients from CHUC shows that donor hepatectomy in P-LDLT is a safe procedure, with low morbidity and without mortality.
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Affiliation(s)
| | - Ricardo Martins
- University of Coimbra, Faculty of Medicine, Coimbra, Portugal.,Surgery Department, Centro Hospitalar e Universitario de Coimbra EPE (CHUC), Coimbra, Portugal
| | - Maria Francelina Lopes
- University of Coimbra, Faculty of Medicine, Coimbra, Portugal.,Pediatric Surgery Departement, Centro Hospitalar e Universitario de Coimbra EPE (CHUC), Coimbra, Portugal
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Shi YX, Zhang HM, Chen J, Huang YQ, Yu MM, Jin YH, Wang WR, Gao W. Health-Related Quality of Life in Predominantly Young Parental Living Liver Donors: A Cross-Sectional Study in China. Front Med (Lausanne) 2021; 8:726103. [PMID: 34660636 PMCID: PMC8517132 DOI: 10.3389/fmed.2021.726103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: The health-related quality of life (HRQoL) of donors deserves attention and must be considered for a long time. Many of the published studies had small sample sizes, and research from mainland China, in particular, is scant. Thus, this study aimed to investigate the HRQoL of living liver donors and identify the influencing factors of the HRQoL in mainland China. Methods: This is a cross-sectional study. The data were collected from the liver transplantation center, the Tianjin First Center Hospital, China. Living liver donors older than 18 years and at a minimum of 1-month, post-donation was included. The HRQoL was evaluated using the Medical Outcome Study Short form 36 (SF-36). Sociodemographic and clinical-related variables, HRQoL status, and its potential impact factors were analyzed. Results: A total of 382 living liver donors completed the survey. The median number of months post-donation was 25, and parental donors (99.2%) were the most frequent relationship. The majority of the participants (372, 97.4%) donated their left lateral lobes. Thirty-two (8.4%) donors suffered complications, and of them, 7 suffered from biliary leakage (1.8%), which was the most common one in this study. The physical functioning (PF), role–physical (RP), bodily pain (BP), general health (GH), social functioning (SF), role–emotional (RE), and mental health (MH) scores among the living liver donors were significantly better than those of the Chinese norms. Short-time post-donation [odds ratio (OR): 0.008; p < 0.001] and male recipients (OR:0.195; p = 0.024) were associated with the likelihood of a poor physical related quality of life. Conclusions: Despite, in general, good HRQoL outcomes, we also believed that liver donation has an obvious influence on the physical functions of liver donors. More attention and long-term follow-ups are necessary for donors at higher risk based on identified influencing factors and correlates.
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Affiliation(s)
- Yue-Xian Shi
- School of Nursing, Peking University, Beijing, China
| | - Hai-Ming Zhang
- Liver Transplantation Center, Clinical Center for Pediatric Liver Transplantation, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Chen
- Department of Liver Transplantation, Tianjin First Center Hospital, Tianjin, China
| | - Ya-Qi Huang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Ming-Ming Yu
- School of Nursing, Peking University, Beijing, China
| | - Yin-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen-Ru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Gao
- Department of Liver Transplantation, Tianjin First Center Hospital, Tianjin, China
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Gupta S, Sinha PK, Patil NS, Mohapatra N, Sindwani G, Garg N, Khillan V, Pamecha V. Randomized control trial on perioperative antibiotic prophylaxis in live liver donors: Are three doses enough? JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:1124-1132. [PMID: 34623761 DOI: 10.1002/jhbp.1053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/08/2021] [Accepted: 09/13/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The duration of perioperative antibiotic prophylaxis following live liver donor hepatectomy (LDH) is not known. METHODS This is a double-blind equivalence trial. All consecutive LDH were randomized into: group A (three doses) and group B (nine doses) of perioperative antibiotics (piperacillin + tazobactam - 4.5 g intravenous) at fixed 8 hourly intervals. Primary end point was incidence of infective complications as per CDC (Centers for Disease Control and Prevention) criteria. Secondary end points were liver function tests, total leukocyte count, international normalized ratio, hospital stay, morbidity, and cost analysis. RESULTS One hundred and twenty-six LDHs were enrolled. A total of 19.8% (n = 25) experienced postoperative complications, 11 (17.7%) in group A and 14 (21.9%) in group B (P = .561). Infective complications were seen in 11 donors (8.1%), five in group A and six in group B (P = .79). A total of 8.1% of donors required continuation/up-gradation of antibiotics in group A and 9.4% in group B. Return to soft diet was delayed in group B (P = .039). Median hospital stay and cost were similar. CONCLUSION Three doses of perioperative antibiotic are equally effective in preventing infective complications.
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Affiliation(s)
- Sahil Gupta
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Piyush Kumar Sinha
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nilesh Sadashiv Patil
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nihar Mohapatra
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gaurav Sindwani
- Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Neha Garg
- Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vikas Khillan
- Department of Clinical Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Viniyendra Pamecha
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
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Vargas PA, McCracken EKE, Mallawaarachchi I, Ratcliffe SJ, Argo C, Pelletier S, Zaydfudim VM, Oberholzer J, Goldaracena N. Donor Morbidity Is Equivalent Between Right and Left Hepatectomy for Living Liver Donation: A Meta-Analysis. Liver Transpl 2021; 27:1412-1423. [PMID: 34053171 DOI: 10.1002/lt.26183] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/15/2021] [Accepted: 05/14/2021] [Indexed: 12/14/2022]
Abstract
Maximizing liver graft volume benefits the living donor liver recipient. Whether maximizing graft volume negatively impacts living donor recovery and outcomes remains controversial. Patient randomization between right and left hepatectomy has not been possible due to anatomic constraints; however, a number of published, nonrandomized observational studies summarize donor outcomes between 2 anatomic living donor hepatectomies. This meta-analysis compares donor-specific outcomes after right versus left living donor hepatectomy. Systematic searches were performed via PubMed, Cochrane, ResearchGate, and Google Scholar databases to identify relevant studies between January 2005 and November 2019. The primary outcomes compared overall morbidity and incidence of severe complications (Clavien-Dindo >III) between right and left hepatectomy in donors after liver donation. Random effects meta-analysis was performed to derive summary risk estimates of outcomes. A total of 33 studies (3 prospective and 30 retrospective cohort) were used to identify 7649 pooled patients (5993 right hepatectomy and 1027 left hepatectomy). Proportion of donors who developed postoperative complications did not significantly differ after right hepatectomy (0.33; 95% confidence interval [CI], 0.27-0.40) and left hepatectomy (0.23; 95% CI, 0.17-0.29; P = 0.19). The overall risk ratio (RR) did not differ between right and left hepatectomy (RR, 1.16; 95% CI, 0.83-1.63; P = 0.36). The relative risk for a donor to develop severe complications showed no differences by hepatectomy side (Incidence rate ratio, 0.97; 95% CI, 0.67-1.40; P = 0.86). There is no evidence that the overall morbidity differs between right and left lobe donors. Publication bias reflects institutional and surgeon variation. A prospective, standardized, multi-institutional study would help quantify the burden of donor complications after liver donation.
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Affiliation(s)
- Paola A Vargas
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Emily K E McCracken
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Indika Mallawaarachchi
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA
| | - Sarah J Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA
| | - Curtis Argo
- Division of Gastroenterology, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Shawn Pelletier
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Victor M Zaydfudim
- Division of Surgical Oncology, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Jose Oberholzer
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Nicolas Goldaracena
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
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Borhani AA, Elsayes KM, Catania R, Kambadakone A, Furlan A, Kierans AS, Kamath A, Harmath C, Horvat N, Humar A, Kielar AZ. Imaging Evaluation of Living Liver Donor Candidates: Techniques, Protocols, and Anatomy. Radiographics 2021; 41:1572-1591. [PMID: 34597229 PMCID: PMC9478886 DOI: 10.1148/rg.2021210012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/05/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022]
Abstract
The need for liver transplants is increasing because the prevalence of liver diseases and the indications for transplants are growing. In response to the shortage of grafts from deceased donors, more transplants are being performed worldwide with grafts from living donors. Radiologic evaluation is an integral component in the assessment of donor candidates to ensure their eligibility and to choose the most appropriate surgical approach. MRI is the preferred modality for evaluation of the liver parenchyma and biliary tree. In most centers, a combination of MRI and CT is used to take advantage of the higher spatial resolution of CT for evaluation of arteries. However, MRI-only assessment is feasible. In addition to assessment of the liver parenchyma for abnormalities such as steatosis, a detailed evaluation of the hepatic vascular and biliary system for pertinent anatomic variants is crucial, because these variants can affect surgical techniques and outcomes in both recipients and donors. In this pictorial article, after a brief review of the most common surgical techniques and postsurgical liver anatomy, the biliary and vascular anatomy are discussed, with specific attention paid to the variants that are pertinent to this surgical procedure. The roles of liver segmentation and volumetric assessment and current imaging techniques and protocols are also discussed. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Amir A. Borhani
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Khaled M. Elsayes
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Roberta Catania
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Avinash Kambadakone
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Alessandro Furlan
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Andrea S. Kierans
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Amita Kamath
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Carla Harmath
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Natally Horvat
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Abhinav Humar
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Ania Z. Kielar
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
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Being Well Informed Is Critical to Informed Consent for Living Liver Donors. Transplantation 2021; 106:1103-1104. [PMID: 34560699 DOI: 10.1097/tp.0000000000003959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Healthcare Resource Utilization After Living Liver Donation: A Retrospective Case-control Study. Transplantation 2021; 106:1201-1205. [PMID: 34560697 DOI: 10.1097/tp.0000000000003958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Living liver donation is generally considered safe, but donors may experience short or long-term complications. The purpose of this study was to assess healthcare resource utilization after liver donation in living liver donors in comparison to the general population. METHODS Outpatient or emergency department visits and hospital admissions were compared between living liver donors who underwent hepatic resection for living liver donation between 2004 and 2018 and the matched general population. Healthcare resource utilization data for 5 years after liver donation were collected from the National Health Insurance Service (NHIS) database. For every living liver donor, 4 individually matched nondonors were selected from the NHIS database using age, sex, preexisting comorbidities, and previous healthcare utilization history. RESULTS A total of 1886 living liver donors and 7309 nondonors were included. In the first year after donation, living liver donors required more outpatient department visits (7 [4-13] vs. 3 [1-7], P < 0.001) and more emergency department visits (13.33% vs. 0.15%, P < 0.001) compared to matched nondonors. A similar trend persisted for 5 years after donation. The number of hospital admissions of living liver donors was higher for up to 2 years after donation with longer hospital length of stay (13.0 [10.5-16.0] vs. 5.0 [3.0-9.0] days, P < 0.0001). CONCLUSIONS Healthcare resource utilization in living liver donors for 5 years after donation were higher compared to matched nondonors. The higher healthcare resource demand may be related to postoperative complications or lowered threshold for healthcare resource utilization after donation.Supplemental Visual Abstract; http://links.lww.com/TP/C291.
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Sonnenberg EM, Lee-Riddle GS, Walls DO, Caicedo JC, Jackson WE, Hughes L, Ladner DP, Liapakis A, Pomfret EA, Sarkar M, Selzner N, Torres AM, Abt PL, Olthoff KM. Pregnancy Outcomes After Living Liver Donation: A Multi-Institutional Study. Liver Transpl 2021; 27:1262-1272. [PMID: 33993632 DOI: 10.1002/lt.26098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 01/13/2023]
Abstract
Nearly half of living liver donors in North America are women of child-bearing age. Fetal and maternal outcomes after donation are unknown. We conducted a retrospective cohort study of female living liver donors (aged 18-50 years at donation) from 6 transplant centers. Participants were surveyed about their pregnancies and fertility. Outcomes were compared between predonation and postdonation pregnancies. Generalized estimating equations were clustered on donor and adjusted for age at pregnancy, parity, and pregnancy year. Among the 276 donors surveyed, 151 donors responded (54.7% response rate) and reported 313 pregnancies; 168/199 (68.8%) of the predonation pregnancies and 82/114 (71.9%) of the postdonation pregnancies resulted in live births, whereas 16.6% and 24.6% resulted in miscarriage, respectively. Women with postdonation pregnancies were older (32.0 versus 26.7 years; P < 0.001) and more frequently reported abnormal liver enzymes during pregnancy (3.5% versus 0.0%; P = 0.02) and delivery via cesarean delivery (35.4% versus 19.7%; P = 0.01). On adjusted analysis, there was no difference in cesarean delivery (odds ratio [OR], 2.44; 95% confidence interval [95% CI], 0.98-6.08), miscarriage (OR, 1.59; 95% CI, 0.78-3.24), combined endpoints of pregnancy-induced hypertension and preeclampsia (OR, 1.27; 95% CI, 0.36-4.49), or intrauterine growth restriction and preterm birth (OR, 0.91; 95% CI, 0.19-4.3). Of the 49 women who attempted pregnancy after donation, 11 (22.5%) self-reported infertility; however, 8/11 (72.7%) eventually had live births. Aside from increased reporting of abnormal liver enzymes and cesarean deliveries, there was no significant difference in pregnancy outcomes before and after living liver donation. One-fifth of women who attempt pregnancy after liver donation reported infertility, and although the majority went on to successful live births, further exploration is needed to understand the contributing factors. Future research should continue to monitor this patient-centered outcome across a large cohort of donors.
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Affiliation(s)
| | - Grace S Lee-Riddle
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David O Walls
- Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Juan C Caicedo
- Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Whitney E Jackson
- Division of Gastroenterology and Hepatology, Department of Medicine, and the Colorado Center for Transplantation Care, Research and Education, University of Colorado, Aurora, CO
| | - Lisa Hughes
- Department of Medicine, Yale University, New Haven, CT
| | - Daniela P Ladner
- Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Elizabeth A Pomfret
- Department of Surgery and the Colorado Center for Transplantation Care, Research and Education, University of Colorado, Aurora, CO
| | - Monika Sarkar
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Nazia Selzner
- Department of Medicine, Toronto General Hospital, Toronto, ON, Canada
| | - Ana Marie Torres
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Peter L Abt
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Kim M Olthoff
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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Kasiske BL, Ahn YS, Conboy M, Dew MA, Folken C, Levan ML, Humar A, Israni AK, Rudow DL, Trotter JF, Massie AB, Musgrove D. Outcomes of living liver donor candidate evaluations in the Living Donor Collective pilot registry. Clin Transplant 2021; 35:e14394. [PMID: 34342054 DOI: 10.1111/ctr.14394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/04/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To gather information on long-term outcomes after living donation, the Scientific Registry of Transplant Recipients (SRTR) conducted a pilot on the feasibility of establishing a comprehensive donor candidate registry. METHODS A convenience sample of 6 US living liver donor programs evaluated 398 consecutive donor candidates in 2018, ending with the March 12, 2020, COVID-19 emergency. RESULTS For 333/398 (83.7%), the donor or program decided whether to donate; 166/333 (49.8%) were approved, and 167/333 (50.2%) were not or opted out. Approval rates varied by program, from 27.0% to 63.3% (median, 46%; intraquartile range, 37.3-51.1%). Of those approved, 90.4% were white, 57.2% were women, 83.1% were < 50 years, and 85.5% had more than a high school education. Of 167 candidates, 131 (78.4%) were not approved or opted out because of: medical risk (10.7%); chronic liver disease risk (11.5%); psychosocial reasons (5.3%); candidate declined (6.1%); anatomical reasons increasing recipient risk (26.0%); recipient-related reasons (33.6%); finances (1.5%); or other (5.3%). CONCLUSIONS A comprehensive national registry is feasible and necessary to better understand candidate selection and long-term outcomes. As a result, the US Health Resources and Services Administration asked SRTR to expand the pilot to include all US living donor programs.
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Affiliation(s)
- Bertram L Kasiske
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.,Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Yoon Son Ahn
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Michael Conboy
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Christian Folken
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Macey L Levan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abhi Humar
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ajay K Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.,Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Dianne LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA
| | - James F Trotter
- Department of Medicine, Baylor University Medical Center, Dallas, Texas, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Donald Musgrove
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | -
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
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Kose A, Altunisik Toplu S, Akbulut S, Yasar S, Sarici KB, Duman Y, Kutlu R, Isik B, Colak YZ, Yilmaz S, Bayindir Y. Evaluation of clinical characteristics and outcomes of postoperative ınfections in living liver donors. Int J Clin Pract 2021; 75:e14324. [PMID: 33960083 DOI: 10.1111/ijcp.14324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/03/2021] [Indexed: 02/05/2023] Open
Abstract
AIM To analyze developing infections after living donor hepatectomy (LDH) in living liver donors (LLDs). METHODS Demographic and clinical characteristics of 1106 LLDs were retrospectively analyzed in terms of whether postoperative infection development. Therefore, LLDs were divided into two groups: with (n = 190) and without (n = 916) antimicrobial agent use. RESULTS The median age was 29.5 (min-max: 18-55). A total of 257 (23.2%) infection attacks (min-max: 1-8) was developed in 190 (17.2%) LLDs. The patients with the infection that were longer intensive care unit (ICU) and hospital stays, higher hospital admissions, emergency transplantation, invasive procedures for ERCP, PTC biloma, and abscess drainage, and the presence of relaparatomies and transcystic catheters. Infection attacks are derived from a 58.3% hepatobiliary system, 13.2% urinary system, 6.6% surgical site, and 5.8% respiratory system. The most common onset symptoms were fever, abdominal pain, nausea, and vomiting. A total of 125 positive results was detected from 77 patients with culture positivity. The most detected microorganisms from the cultures taken are Extended-Spectrum β-lactamases (ESBL) producing Klebsiella pneumonia (16.8%) and Escherichia coli (16%), Methicillin-Resistant Staphylococcus aureus [(MRSA) (9.6%)], Methicillin-susceptible S aureus [(MSSA) (9.6%)], and Pseudomonas aeruginosa (8.8%), respectively. The average number of ICU hospitalization days was 3 ± 2 (min 1-max 30, IQR:1) and hospitalization days was 14 ± 12 (min 3-max 138, IQR: 8). All infection attacks were successfully treated. No patients died because of infection or another surgical complication. CONCLUSION Infections commonly observed infected biloma, cholangitis, and abscess arising from the biliary system and other nosocomial infections are the feared complications in LLDs. These infections should be managed multidisciplinary without delay and carefully.
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Affiliation(s)
- Adem Kose
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sibel Altunisik Toplu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sami Akbulut
- Department of Liver Transplantation Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Seyma Yasar
- Department of Biostatistics, and Medical Informatics, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Kemal Baris Sarici
- Department of Liver Transplantation Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Yucel Duman
- Department of Medical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Burak Isik
- Department of Liver Transplantation Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Yusuf Ziya Colak
- Department of Anesthesiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Liver Transplantation Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Yasar Bayindir
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
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49
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Hong SK, Choe S, Yi NJ, Shin A, Choe EK, Yoon KC, Lee KW, Suh KS. Long-term Survival of 10,116 Korean Live Liver Donors. Ann Surg 2021; 274:375-382. [PMID: 31850982 DOI: 10.1097/sla.0000000000003752] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the long-term mortality of Korean live liver donors using data from a national donor registry by comparing it with the mortality of the general population. SUMMARY OF BACKGROUND DATA Although live liver donors generally have a healthy status, their long-term mortality has not been properly addressed in a large donor registry. METHODS Data of 10,116 live liver donors were drawn from a mandated national registry of Korean live liver donors between 2000 and 2015. Matched controls were selected from the Korean National Health Insurance System-National Sample Cohort (NHIS-NSC). Median (range) follow-up of liver donors was 5.7 (0-15.9) years. Donors were 1:3 individually matched to controls by sex and 5-year age group; potential controls were from the whole NHIS-NSC (Control 1) or from NHIS-NSC after excluding people with contraindications to be organ donors (Control 2) (donor, n = 7538; Control 1, n = 28,248; Control 2, n = 28,248). RESULTS Fifty-three deaths occurred after donation. Ten-year cumulative mortality of live liver donors was 0.9%. The most common cause of death was suicide (n = 19) followed by cancer (n = 9) and traffic accident (n = 7). In the matched control analysis, overall risk of death was significantly lower in donors than in Control 1 (P < 0.001), but higher than in Control 2 (P < 0.001). CONCLUSIONS Liver donors have increased long-term mortality risk compared to similar healthy controls without contraindications to be organ donors. Therefore, long-term follow-up, including psychosocial support, is needed for live liver donors.
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Affiliation(s)
- Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine
| | - Sunho Choe
- Department of Preventive Medicine, Seoul National University College of Medicine
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine
| | - Eun Kyung Choe
- Department of Surgery, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center
| | - Kyung Chul Yoon
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine
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Flaig C, Humar A, Kirshner E, Hughes C, Ganesh S, Tevar A, Steel JL. Post-operative outcomes in anonymous living liver donors: What motivates individuals to donate to strangers. Clin Transplant 2021; 35:e14438. [PMID: 34292636 DOI: 10.1111/ctr.14438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022]
Abstract
Anonymous living donor liver transplantation (LDLT) is a strategy to address the shortage of available transplantable livers; however, few studies have been conducted on this population. The objective of this study was to describe the motivations and medical, psychosocial, and financial outcomes of anonymous living liver donors. Between 2010-2019, 116 anonymous living liver donors were evaluated, 59 (51.7%) of whom proceeded to surgery. A subset of 21 anonymous donors were matched to biologically/emotionally related donors according to age, gender, race, and duration since surgery. A medical chart review and post-surgical interviews were performed to assess medical and financial outcomes. The primary motivation for donors was an unselfish desire to help others (43, 72.9%). A total of 13 (22%) anonymous donors experienced complications. Of these, 7 (11.9%) were grade I Clavien-Dindo classification, 5 (8.5%) grade II, and 1 was grade III (1.7%); and no patients had grade IV-V Clavien-Dindo complications. Increased anxiety was reported by 3 (5.1%) donors, and one donor reported clinical levels of depression (1.7%). Within the matched controls, anonymous donors were not significantly different to biologically/emotionally related donors with regard to surgical complications, psychosocial, or financial outcomes. Allowing a greater number of anonymous donors may facilitate the reduction of the waitlist for liver transplant candidates. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Carly Flaig
- University of Pittsburgh School of Medicine Department of Surgery.,University of Pittsburgh Department of Psychology
| | - Abhinav Humar
- University of Pittsburgh School of Medicine Department of Surgery
| | - Emily Kirshner
- University of Pittsburgh School of Medicine Department of Surgery
| | | | - Swaytha Ganesh
- University of Pittsburgh School of Medicine Department of Surgery
| | - Amit Tevar
- University of Pittsburgh School of Medicine Department of Surgery
| | - Jennifer L Steel
- University of Pittsburgh School of Medicine Department of Surgery.,University of Pittsburgh Department of Psychology.,University of Pittsburgh School of Medicine Department of Psychiatry
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