The Impact of Minimally-Invasive open Donor Hepatectomy on Outcomes in Adult Living Donor Liver Transplantation

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Abstract

Aim

Technical problems in adult living donor liver transplantation (LDLT) has been almost overcome, which resulted in recent improvement of recipient outcomes for most centers. However, the outcome of minimally-invasive donor hepatectomy (MIDH) has not been well established. In this study, we evaluate the impact of MIDH on the outcomes through our 20-year LDLT experience.

Methods

Six hundred and four adult living donors were included in the study, after excluding donors with left lateral segment (n=64), S2-monosegment (n=3) and posterior segment (n=12) grafts. MIDH using a minimal upper midline incision was introduced since August 2012 and exclusively used since then. Various clinical parameters of MIDH (n=188) were compared with those of conventional donor hepatectomy (CDH, n=417).

Results

The mean wound length of the MIDH group was 13.3±2.2cm. Right lobe grafts were more often utilized in the MIDH group as compared to the MIDH group (34.8% vs. 58.0%, p<0.0001). Operative time (430±105 vs. 297±61 min, p<0.0001) and blood loss (538±404 vs. 295±254ml, p<0.0001) were significantly less in the MIDH group. Postoperative liver function tests including peak Total bilirubin (2.5±1.4 vs. 2.1±1.0mg/dl, p=0.0001) and peak ALT (525±275 vs. 481±246IU/L, p<0.05) were significantly better in the MIDH group. Furthermore, incidence of overall complications (25.6 vs. 5.9%, p<0.0001) and Clavien 3≤ complications (7.4 vs. 2.1%, p<0.0001) were markedly reduced in the MIDH group. Accordingly, the length of postoperative hospital stay (14.0±7.5 vs. 9.0±7.9days, p<0.0001) was significantly shorter in the MIDH group. There was neither intraoperative autologous transfusion, nor irreversible disability as well as mortality experienced throughout the period.

Conclusion

MIDH is safe and should be the standard procedure in adult LDLT. Further study which compares MIDH with laparoscopic donor hepatectomy is warranted in the near future.

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