Krishna P, Rammohan A, Rajalingam R, Narasimhan G, Cherukuru R, Sachan D, Rajakumar A, Kaliamoorthy I, Reddy M S, Rela M
Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India.
Hepatol Int. 2024 Feb;18(1):265-272. doi: 10.1007/s12072-023-10583-0. Epub 2023 Sep 12.
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.
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.
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.
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%.
葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症（G6PDd）可在手术应激后引发溶血。区分G6PDd相关的术后溶血性发作（PHE）和肝切除术后肝衰竭可能具有挑战性，尤其是在活体供体中，供体安全至关重要。我们分析了我们的G6PDd肝供体队列的结果。
如果没有其他合适的家庭供体，无溶血证据的G6PDd个体被视为活体供体。使用倾向得分匹配法，将接受左外侧/左叶捐献（LL组）和右叶捐献（RL组）的G6PDd供体的结果与按1:3比例匹配的非G6PDd供体进行比较。
在研究期间，59名G6PDd供体（占1011名的5.8%）接受了活体供肝切除术（LiDH）。与匹配的对照组相比，LL-G6PDd供体（22.37%）术后胆红素峰值水平较高，但在发病率或术后输血需求方面无差异。与匹配的非G6PDd队列相比，RL-G6PDd供体（37.63%）的胆红素峰值水平更高、发病率更高（16.2%对3.6%，p = 0.017）且术后输血更多（21.6%对6.4%，p = 0.023）。四名RL-G6PDd供体（10.8%）发生了PHE。低G6PD活性（15%对40%，p = 0.034）和较低的未来肝脏残余量（FLR）（34.3%对37.8%，p = 0.05）被确定为PHE的危险因素。
我们报告了迄今为止最大规模的接受LiDH的G6PDd个体系列，并证实了G6PDd中左叶捐献的安全性。我们的分析确定了PHE的特定危险因素，并建议当FLR小于36%时，G6PD活性低于25%的个体应避免右叶LiDH。
