Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Different techniques for harvesting grafts for living donor liver transplantation: A systematic review and meta-analysis
Hui Li, Jun-Bin Zhang, Xiao-Long Chen, Lei Fan, Li Wang, Shi-Hui Li, Qiao-Lan Zheng, Xiao-Ming Wang, Yang Yang, Gui-Hua Chen, Gen-Shu Wang
Hui Li, Jun-Bin Zhang, Xiao-Long Chen, Lei Fan, Li Wang, Shi-Hui Li, Yang Yang, Gui-Hua Chen, Gen-Shu Wang, Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Hui Li, Jun-Bin Zhang, Xiao-Long Chen, Lei Fan, Li Wang, Shi-Hui Li, Yang Yang, Gui-Hua Chen, Gen-Shu Wang, Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, Guangdong Province, China
Qiao-Lan Zheng, Journal Publishing center of The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Xiao-Ming Wang, Department of Hepatobiliary Surgery, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu 241001, Anhui Province, China
Yang Yang, Gui-Hua Chen, Gen-Shu Wang, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Wang GS took responsibility for the integrity of the data and the accuracy of the data analysis; Li H, Wang XM, Yang Y, Chen GH and Wang GS contributed to study design, drafting the manuscript, administrative support and supervision; Li H and Fan L acquired the data; Li H, Zhang JB and Chen XL analyzed and interpreted the data; Zheng QL contributed to statistical analysis; Wang XM, Wang GS and Chen GH revised the manuscript.
Supported by Science and Technology Planning Project of Guangzhou, No. 201604020001.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gen-Shu Wang, MD, PhD, Professor, Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China.
wgsh168@163.com
Telephone: +86-20-85252185 Fax: +86-20-85252276
Received: October 23, 2016
Peer-review started: October 28, 2016
First decision: December 29, 2016
Revised: March 21, 2017
Accepted: April 12, 2017
Article in press: April 12, 2017
Published online: May 28, 2017
Processing time: 215 Days and 2 Hours
AIM
To perform a systematic review and meta-analysis on minimally vs conventional invasive techniques for harvesting grafts for living donor liver transplantation.
METHODS
PubMed, Web of Science, EMBASE, and the Cochrane Library were searched comprehensively for studies comparing MILDH with conventional living donor hepatectomy (CLDH). Intraoperative and postoperative outcomes (operative time, estimated blood loss, postoperative liver function, length of hospital stay, analgesia use, complications, and survival rate) were analyzed in donors and recipients. Articles were included if they: (1) compared the outcomes of MILDH and CLDH; and (2) reported at least some of the above outcomes.
RESULTS
Of 937 articles identified, 13, containing 1592 patients, met our inclusion criteria and were included in the meta-analysis. For donors, operative time [weighted mean difference (WMD) = 20.68, 95%CI: -6.25-47.60, P = 0.13] and blood loss (WMD = -32.61, 95%CI: -80.44-5.21, P = 0.18) were comparable in the two groups. In contrast, analgesia use (WMD = -7.79, 95%CI: -14.06-1.87, P = 0.01), postoperative complications [odds ratio (OR) = 0.62, 95%CI: 0.44-0.89, P = 0.009], and length of hospital stay (WMD): -1.25, 95%CI: -2.35-0.14, P = 0.03) significantly favored MILDH. No differences were observed in recipient outcomes, including postoperative complications (OR = 0.93, 95%CI: 0.66-1.31, P = 0.68) and survival rate (HR = 0.96, 95%CI: 0.27-3.47, P = 0.95). Funnel plot and statistical methods showed a low probability of publication bias.
CONCLUSION
MILDH is safe, effective, and feasible for living donor liver resection with fewer donor postoperative complications, reduced length of hospital stay and analgesia requirement than CLDH.
Core tip: Minimally invasive procedures have been increasingly used in liver resection, as they are considered safe and effective. Concerns have been raised, however, about the feasibility and donor safety of minimally invasive living donor hepatectomy. We analyzed 13 articles, containing 1592 patients, to compare two techniques for harvesting grafts for living donor liver transplantation. Finally, we concluded that minimally invasive procedures are safe, effective, and feasible for living donor liver resection, with fewer donor postoperative complications and reduced length of hospital stay and analgesia requirement than conventional approaches.
