RESUMO
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.
RESUMO
INTRODUCTION: There are unique technical and management challenges associated with living donor liver transplantation (LDLT) for Budd-Chiari Syndrome (BCS). The outcomes of LDLT for BCS in comparison to other indications remain unclear and warrant elucidation. METHODS: Data of 24 BCS patients who underwent LDLT between January 2012 and June 2019 were analyzed. There were 20 adults and 4 children. The early and long-term outcomes of adult LDLT BCS patients were compared to a control group of LDLT patients for other indications and matched using propensity scoring methodology. RESULTS: Primary BCS was observed in 18 (90%) patients. Caval replacement was performed in 7 (35%) patients. Early and late hepatic venous outflow tract (HVOT) complications were seen in 1 (5%) and 3 (15%) patients. Preoperative acute kidney injury was identified as a risk factor for mortality in the BCS cohort (p = 0.013). On comparison, BCS recipients were younger with fewer comorbidities, more large volume ascites and higher rates of PVT. They also had longer cold ischemia time, increased blood loss and transfusion requirements, increased hospital stay, and higher late outflow complications. The 1-year and 3-year survivals were similar to non-BCS cohort (84.2% vs. 94% and 71.3% vs. 91.9%, respectively, log rank test p = 0.09). CONCLUSION: LDLT is a good option for symptomatic BCS who have failed non-transplant interventions. The clinical and risk factor profile of BCS recipients is distinct from non-BCS recipients. By following an algorithmic management protocol, we show on propensity-score matched analysis that outcomes of LDLT for BCS are similar to non-BCS indications.
