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Master of Public Health

Donor Morbidity Is Equivalent Between Right and Left Hepatectomy For Living Liver Donation: A meta-analysis

AUTHORS

Vargas PA , McCracken EK , Mallawaarachchi I , Ratcliffe SJ , Argo C , Pelletier S , Zaydfudim VM , Oberholzer J , Goldaracena N , . Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2021 5 30; ().

ABSTRACT

RATIONALE: Maximizing liver graft volume benefits the living donor liver recipient. Whether maximizing graft volume negatively impacts living donor recovery and outcomes remains controversial. Patient randomization between right and left hepatectomy has not been possible due to anatomic constraints; however, a number of published, non-randomized observational studies summarize donor outcomes between two anatomic living donor hepatectomies. This meta-analysis compares donor-specific outcomes after right vs. left living donor hepatectomy.

METHODS: Systematic searches were performed via PubMed, Cochrane, ResearchGate and Google Scholar databases to identify relevant studies between January 2005 and November 2019. The primary outcomes compared overall morbidity and incidence of severe complications (Clavien-Dindo >III) between right and left hepatectomy in donors after liver donation. Random effects meta-analysis was performed to derive summary risk estimates of outcomes.

RESULTS: A total of 33 studies (3 prospective and 30 retrospective cohort) were used to identify 7,649 pooled patients included in the study (5993 right hepatectomy and 1027 left hepatectomy). Proportion of donors who developed postoperative complications did not significantly differ after right hepatectomy (0.33, 95% CI: 0.27-0.40) and left hepatectomy (0.23, 95% CI: 0.17-0.29), p=0.19. The overall risk ratio did not differ between right vs. left hepatectomy (RR=1.16 95% CI: 0.83-1.63, p=0.36). The relative risk for a donor to develop severe complications showed no differences by hepatectomy side (IRR=0.97 (95% CI: 0.67, 1.40) p=0.86.

CONCLUSION: There is no evidence that the overall morbidity differs between right and left lobe donors. Publication bias reflects institutional and surgeon variation. A prospective, standardized, multi-institutional study would help quantify the burden of donor complications after liver donation.

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