Donor Morbidity Is Equivalent Between Right and Left Hepatectomy for Living Liver Donation: A Meta-Analysis
Paola A. Vargas
Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
These authors contributed equally to this work.
Search for more papers by this authorEmily K.E. McCracken
Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
These authors contributed equally to this work.
Search for more papers by this authorIndika Mallawaarachchi
Division of Biostatistics, Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA
Search for more papers by this authorSarah J. Ratcliffe
Division of Biostatistics, Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA
Search for more papers by this authorCurtis Argo
Division of Gastroenterology, Department of Medicine, University of Virginia Health System, Charlottesville, VA
Search for more papers by this authorShawn Pelletier
Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
Search for more papers by this authorVictor M. Zaydfudim
Division of Surgical Oncology, Department of Surgery, University of Virginia Health System, Charlottesville, VA
Search for more papers by this authorJose Oberholzer
Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
Search for more papers by this authorCorresponding Author
Nicolas Goldaracena
Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
Address reprint requests to Nicolas Goldaracena, M.D., Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, P.O. Box 800709, Charlottesville, VA 22908. Telephone: 434-924-9462; FAX: 434-924-5539; E-mail: [email protected]
Search for more papers by this authorPaola A. Vargas
Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
These authors contributed equally to this work.
Search for more papers by this authorEmily K.E. McCracken
Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
These authors contributed equally to this work.
Search for more papers by this authorIndika Mallawaarachchi
Division of Biostatistics, Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA
Search for more papers by this authorSarah J. Ratcliffe
Division of Biostatistics, Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA
Search for more papers by this authorCurtis Argo
Division of Gastroenterology, Department of Medicine, University of Virginia Health System, Charlottesville, VA
Search for more papers by this authorShawn Pelletier
Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
Search for more papers by this authorVictor M. Zaydfudim
Division of Surgical Oncology, Department of Surgery, University of Virginia Health System, Charlottesville, VA
Search for more papers by this authorJose Oberholzer
Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
Search for more papers by this authorCorresponding Author
Nicolas Goldaracena
Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
Address reprint requests to Nicolas Goldaracena, M.D., Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, P.O. Box 800709, Charlottesville, VA 22908. Telephone: 434-924-9462; FAX: 434-924-5539; E-mail: [email protected]
Search for more papers by this authorPotential conflict of interest: Nothing to report.
Abstract
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, nonrandomized observational studies summarize donor outcomes between 2 anatomic living donor hepatectomies. This meta-analysis compares donor-specific outcomes after right versus left living donor hepatectomy. 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. A total of 33 studies (3 prospective and 30 retrospective cohort) were used to identify 7649 pooled patients (5993 right hepatectomy and 1027 left hepatectomy). Proportion of donors who developed postoperative complications did not significantly differ after right hepatectomy (0.33; 95% confidence interval [CI], 0.27-0.40) and left hepatectomy (0.23; 95% CI, 0.17-0.29; P = 0.19). The overall risk ratio (RR) did not differ between right and 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 (Incidence rate ratio, 0.97; 95% CI, 0.67-1.40; P = 0.86). 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.
Supporting Information
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