ABSTRACT
One of the concerns specific to minimally invasive donor hepatectomy(MIDH) is the prolonged time required for graft extraction after completion of the donor hepatectomy(donor warm ischemic time(DWIT)). There has never been an objective evaluation of MIDH-DWIT on allograft function in living donor liver transplantation(LDLT).We evaluated the effect of DWIT following robotic donor hepatectomy(RDH) on recipient outcomes and compared them with a matched cohort of open donor hepatectomy (ODH).Demographic, perioperative and recipient's post-operative outcome data for all right lobe(RL)-RDH performed between September 2019 and July 2023 was analysed and compared with a propensity-score matched cohort(1:1) of RL-ODH from the same time period. Of a total of 103 RL-RDH and 446 RL-ODH, unmatched and Propensity-score matched analysis(1:1) revealed a significantly longer DWIT in the RDH group as compared to the ODH group (9.33±3.95 Vs 2.87±2.13, p<0.0001). This did not translate into any difference in the rates of early allograft dysfunction (EAD), biliary complications(BC), major morbidity or overall 1-& 3-month survival. ROC curve analysis threshold for DWIT-EAD was 9min (AUROC:0.67,sensitivity=80%,specificity=53.8%).We show that prolonged DWIT within an acceptable range in RDH does not have deleterious effects on short-term recipient outcomes. Further long-term studies are required to confirm our findings especially with regards to non-anastomotic BC.
ABSTRACT
INTRODUCTION: Glucose 6 phosphate dehydrogenase (G6PD) deficiency (G6PDd) can trigger hemolysis following surgical stress. Differentiating G6PDd-related post-operative hemolytic episodes (PHE) and post-hepatectomy liver failure may be challenging especially in living donors where donor safety is paramount. We analysed outcomes of our cohort of G6PDd liver donors. METHODS: G6PDd individuals with no evidence of hemolysis were considered as living donors if there was no alternative family donor. Outcomes of G6PDd donors undergoing left lateral/left lobe donation (Group LL) and right lobe donation (Group RL) were compared with non-G6PDd donors matched in a 1:3 ratio using propensity score matching. RESULTS: 59 G6PDd donors (5.8% of 1011) underwent living donor hepatectomy (LiDH) during the study period. LL-G6PDd donors (22.37%) had higher post-operative peak bilirubin level compared to matched controls, but no difference in morbidity or need for post-operative blood transfusion.RL-G6PDd donors (37.63%) had higher peak bilirubin level, morbidity (16.2% vs. 3.6%, p = 0.017) and more post-operative blood transfusion (21.6% vs. 6.4%, p = 0.023) as compared to matched non-G6PDd cohort. Four RL-G6PDd donors (10.8%) developed PHE. Low G6PD activity (15% vs. 40%, p = 0.034) and lower future liver remnant (FLR) (34.3% vs. 37.8%, p = 0.05) were identified as risk factors for PHE. CONCLUSION: We report the largest to-date series of G6PDd individuals undergoing LiDH and confirm the safety of LL donation in G6PDd. Our analysis identifies specific risk factors for PHE and suggests that right lobe LiDH be avoided in individuals with less than 25% G6PD activity when the FLR is less than 36%.
