Haruki Koichiro, Krishnamurthy Jagadeesh, Kumar Olaniya Mukesh, Shankar Sadhana, Rammohan Ashwin, Rhu Jinsoo, Yilmaz Tonguc Utku, Toshima Takeo, Waisberg Daniel Reis, Andraus Wellington, Lee Jaewon, Okumura Shinya, Gopal Prasanna, Hara Takanobu, Sakurai Yuto, Takahashi Ryugen, Zamora-Valdes Daniel, Yang Zhe, Minnee Robert C, Rela Mohamed, Gupta Subash, Ikegami Toru, Lee Kwang-Woong
Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Department of Liver Transplant and HPB Surgeries, Max Super Speciality Hospital, Saket, New Delhi, India.
Liver Transpl. 2025 Jun 24. doi: 10.1097/LVT.0000000000000660.
Although living liver donor safety is a fundamental principle in living donor liver transplantation, the details of severe complications that require re-operation or intensive care are not well understood. Therefore, in this study, we summarize those events in liver donation and investigate the difference in complication rates between the open and laparoscopic/robotic approaches in the era of minimally invasive surgery (MIS). We collected the case report forms of donor Clavien-Dindo grade IIIb, IV, and V complications between January 2013 and December 2022 from 16 institutions in the Vanguard Multicenter Study of the International Living Donor Liver Transplantation Group. We then analyzed the difference in complication rates between the open and MIS (laparoscopic/robotic) approaches. A total of 10,025 donor hepatectomies were performed across 16 institutions (8,310 by open or hybrid, 1,479 by laparoscopic, and 236 by robotic). Overall, Clavien-Dindo grade IIIb and IV complications were observed in 1.17% and 0.12%, respectively. There was no mortality in the period. The incidence of grade IIIb and IV complications was comparable between open and MIS cases (1.08% vs. 1.57%, p =0.09, 0.14% vs. 0%, p =0.12). The incidence of postoperative bleeding was more frequent in MIS cases ( p <0.01), especially from the IVC ( p =0.05) and abdominal wall ( p <0.01), compared with those in open cases. The overall incidence of severe complications in liver donation was comparable between the open and MIS approaches. The site of postoperative bleeding differed by surgical approach, suggesting the potential need for different care for MIS to reduce the postoperative complications in donor hepatectomy.
尽管活体肝供体的安全性是活体肝移植的一项基本原则，但对于需要再次手术或重症监护的严重并发症的细节，人们了解得并不充分。因此，在本研究中，我们总结了肝捐赠中的这些事件，并调查了微创手术（MIS）时代开放手术与腹腔镜/机器人手术方法在并发症发生率上的差异。我们收集了国际活体肝移植组织先锋多中心研究中16家机构在2013年1月至2022年12月期间供体Clavien-Dindo IIIb级、IV级和V级并发症的病例报告表。然后我们分析了开放手术与MIS（腹腔镜/机器人）手术方法在并发症发生率上的差异。16家机构共进行了10,025例供体肝切除术（开放或混合手术8,310例，腹腔镜手术1,479例，机器人手术236例）。总体而言，分别观察到Clavien-Dindo IIIb级和IV级并发症的发生率为1.17%和0.12%。在此期间无死亡病例。开放手术和MIS病例中IIIb级和IV级并发症的发生率相当（1.08%对1.57%，p = 0.09；0.14%对0%，p = 0.12）。与开放手术病例相比，MIS病例术后出血的发生率更高（p < 0.01），尤其是下腔静脉出血（p = 0.05）和腹壁出血（p < 0.01）。肝捐赠中严重并发症的总体发生率在开放手术和MIS手术方法之间相当。术后出血部位因手术方式而异，这表明可能需要对MIS采取不同的护理措施以减少供体肝切除术后的并发症。
