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Different techniques for harvesting grafts for living donor liver transplantation: A systematic review and meta-analysis

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World Journal of Gastroenterology 2017年第20期23卷 3730-3743页

作者： 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 Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital Organ Transplantation InstituteSun Yat-Sen University Organ Transplantation Research Center of Guangdong Province Journal Publishing Center of The Third Affiliated Hospital Sun Yat-Sen University Department of Hepatobiliary Surgery Yijishan Hospital Affiliated to Wannan Medical College Guangdong Key Laboratory of Liver Disease Research the Third Affiliated Hospital of Sun Yat-Sen University

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.

关键词： Living donor hepatectomy graft harvesting Minimally invasive techniques Conventional invasive approaches Meta-analysis

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