Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지
DOI QR코드

DOI QR Code

Donor body mass index over 30 is no barrier for pure laparoscopic donor right hepatectomy

  • Suk Kyun Hong (Department of Surgery, Seoul National University College of Medicine) ;
  • Minseob Kim (Department of Surgery, Seoul National University College of Medicine) ;
  • Youngjin Kim (Department of Surgery, Seoul National University College of Medicine) ;
  • Jae-Yoon Kim (Department of Surgery, Seoul National University College of Medicine) ;
  • Jaewon Lee (Department of Surgery, Seoul National University College of Medicine) ;
  • Jiyoung Kim (Department of Surgery, Seoul National University College of Medicine) ;
  • Su Young Hong (Department of Surgery, Seoul National University College of Medicine) ;
  • Jeong-Moo Lee (Department of Surgery, Seoul National University College of Medicine) ;
  • YoungRok Choi (Department of Surgery, Seoul National University College of Medicine) ;
  • Nam-Joon Yi (Department of Surgery, Seoul National University College of Medicine) ;
  • Kwang-Woong Lee (Department of Surgery, Seoul National University College of Medicine) ;
  • Kyung-Suk Suh (Department of Surgery, Seoul National University College of Medicine)
  • Received : 2024.01.22
  • Accepted : 2024.03.12
  • Published : 2024.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Backgrounds/Aims: Challenges arise when translating pure laparoscopic donor right hepatectomy (PLDRH) results from Asian to Western donors, due to differences in body mass index (BMI). This study compares the outcomes of PLDRH and conventional open donor right hepatectomy (CDRH) in donors with BMI over 30. Methods: Medical records of live liver donors (BMI > 30) undergoing right hepatectomy (2010-2021) were compared: 25 PLDRH cases vs. 19 CDRH cases. Donor and recipient demographics, operative details, and outcomes were analyzed. Results: PLDRH and CDRH had similar donor and recipient characteristics. PLDRH had longer liver removal and warm ischemic times, but a shorter post-liver removal duration than CDRH. Donor complication rates were comparable, with the highest complication being grade IIIa in PLDRH, necessitating needle aspiration for biloma on postoperative day 11. Fortunately, this donor fully recovered without additional treatment. No complications exceeding Clavien-Dindo grade IIIa occurred in either group. Recipient outcomes between the groups were similar. Conclusions: This study supports PLDRH as a viable option for donors with BMI over 30, challenging the notion that high BMI should deter considering PLDRH. The findings provide valuable insights into the safety and feasibility of PLDRH, encouraging further exploration of this technique in diverse donor populations.

Keywords

References

  1. Cherqui D, Soubrane O, Husson E, Barshasz E, Vignaux O, Ghimouz M, et al. Laparoscopic living donor hepatectomy for liver transplantation in children. Lancet 2002;359:392-396. 
  2. Rotellar F, Pardo F, Benito A, Marti-Cruchaga P, Zozaya G, Lopez L, et al. Totally laparoscopic right-lobe hepatectomy for adult living donor liver transplantation: useful strategies to enhance safety. Am J Transplant 2013;13:3269-3273. 
  3. Samstein B, Cherqui D, Rotellar F, Griesemer A, Halazun KJ, Kato T, et al. Totally laparoscopic full left hepatectomy for living donor liver transplantation in adolescents and adults. Am J Transplant 2013;13:2462-2466. 
  4. Soubrane O, Perdigao Cotta F, Scatton O. Pure laparoscopic right hepatectomy in a living donor. Am J Transplant 2013;13:2467-2471. 
  5. Buell JF, Cherqui D, Geller DA, O'Rourke N, Iannitti D, Dagher I, et al. The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg 2009;250:825-830. 
  6. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, et al. Recommendations for laparoscopic liver resection. Ann Surg 2015;261:619-629. 
  7. Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, et al. The southampton consensus guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg 2018;268:11-18. 
  8. Cherqui D, Ciria R, Kwon CHD, Kim KH, Broering D, Wakabayashi G, et al. Expert consensus guidelines on minimally invasive donor hepatectomy for living donor liver transplantation from innovation to implementation: a joint initiative from the International Laparoscopic Liver Society (ILLS) and the Asian-Pacific Hepato-Pancreato-Biliary Association (A-PHPBA). Ann Surg 2021;273:96-108. 
  9. Suh KS, Hong SK, Lee KW, Yi NJ, Kim HS, Ahn SW, et al. Pure laparoscopic living donor hepatectomy: focus on 55 donors undergoing right hepatectomy. Am J Transplant 2018;18:434-443. 
  10. Hong SK, Tan MY, Worakitti L, Lee JM, Cho JH, Yi NJ, et al. Pure laparoscopic versus open right hepatectomy in live liver donors: a propensity score-matched analysis. Ann Surg 2022;275:e206-e212. 
  11. Hong SK, Kim JY, Lee J, Kim J, Choi HH, Lee S, et al. Pure laparoscopic donor hepatectomy: experience of 556 cases at Seoul National University Hospital. Am J Transplant 2024;24:222-238. 
  12. Hong SK, Lee KW, Choi Y, Kim HS, Ahn SW, Yoon KC, et al. Initial experience with purely laparoscopic living-donor right hepatectomy. Br J Surg 2018;105:751-759. 
  13. Lee KW, Hong SK, Suh KS, Kim HS, Ahn SW, Yoon KC, et al. One hundred and fifteen cases of pure laparoscopic living donor right hepatectomy at a single center. Transplantation 2018;102:1878-1884. 
  14. Cho HD, Samstein B, Chaundry S, Kim KH. Minimally invasive donor hepatectomy, systemic review. Int J Surg 2020;82:187-191. 
  15. Rhu J, Choi GS, Kim JM, Kwon CHD, Joh JW. Complete transition from open surgery to laparoscopy: 8-year experience with more than 500 laparoscopic living donor hepatectomies. Liver Transplant 2022;28:1158-1172. 
  16. Hong SK, Choi GS, Han J, Cho HD, Kim JM, Han YS, et al. Pure laparoscopic donor hepatectomy: a multicenter experience. Liver Transpl 2021;27:67-76. 
  17. Lee JG, Lee KW, Kwon CHD, Chu CW, Kim BW, Choi DL, et al. Donor safety in living donor liver transplantation: the Korean organ transplantation registry study. Liver Transpl 2017;23:999-1006. 
  18. Lin JS, Muhammad H, Lin T, Kamel I, Baghdadi A, Rizkalla N, et al. Donor BMI and post-living donor liver transplantation outcomes: a preliminary report. Transplant Direct 2023;9:e1431. 
  19. Kwong AJ, Ebel NH, Kim WR, Lake JR, Smith JM, Schladt DP, et al. OPTN/SRTR 2021 annual data report: liver. Am J Transplant 2023;23:S178-S263. 
  20. Moss J, Lapointe-Rudow D, Renz JF, Kinkhabwala M, Dove LM, Gaglio PJ, et al. Select utilization of obese donors in living donor liver transplantation: implications for the donor pool. Am J Transplant 2005;5:2974-2981. 
  21. Dirican A, Ozsoy M, Ates M, Ersan V, Gonultas F, Isik B, et al. Consequences of the use of extended criteria donors in living donor liver transplantation. Ann Transplant 2015;20:211-217. 
  22. Knaak M, Goldaracena N, Doyle A, Cattral MS, Greig PD, Lilly L, et al. Donor BMI >30 is not a contraindication for live liver donation. Am J Transplant 2017;17:754-760. 
  23. Jin YJ, Kim KM, Hwang S, Lee SG, Ha TY, Song GW, et al. Exercise and diet modification in non-obese non-alcoholic fatty liver disease: analysis of biopsies of living liver donors. J Gastroenterol Hepatol 2012;27:1341-1347. 
  24. Ryan CK, Johnson LA, Germin BI, Marcos A. One hundred consecutive hepatic biopsies in the workup of living donors for right lobe liver transplantation. Liver Transpl 2002;8:1114-1122. 
  25. Hong SK, Suh KS, Cho JH, Lee JM, Yi NJ, Lee KW. Influence of body mass index ≥30 on pure laparoscopic donor right hepatectomy. Ann Transplant 2020;25:e923094. 
  26. Suh KS, Suh SW, Lee JM, Choi Y, Yi NJ, Lee KW. Recent advancements in and views on the donor operation in living donor liver transplantation: a single-center study of 886 patients over 13 years. Liver Transpl 2015;21:329-338. 
  27. Nugroho A, Kim OK, Lee KW, Song S, Kim H, Hong SK, et al. Evaluation of donor workups and exclusions in a single-center experience of living donor liver transplantation. Liver Transpl 2017;23:614-624. 
  28. Suh KS, Hong SK, Yi NJ, Lee KW, Kim HS, Yoon KC, et al. Pure 3-dimensional laparoscopic extended right hepatectomy in a living donor. Liver Transpl 2016;22:1431-1436. 
  29. Hong SK, Suh KS, Yoon KC, Lee JM, Cho JH, Yi NJ, et al. The learning curve in pure laparoscopic donor right hepatectomy: a cumulative sum analysis. Surg Endosc 2019;33:3741-3748. 
  30. Yi NJ, Suh KS, Suh SW, Chang YR, Hong G, Yoo T, et al. Excellent outcome in 238 consecutive living donor liver transplantations using the right liver graft in a large volume single center. World J Surg 2013;37:1419-1429. 
  31. Hong SK, Lee KW, Kim HS, Yoon KC, Ahn SW, Choi JY, et al. Optimal bile duct division using real-time indocyanine green near-infrared fluorescence cholangiography during laparoscopic donor hepatectomy. Liver Transpl 2017;23:847-852. 
  32. Kim J, Hong SK, Lim J, Lee JM, Cho JH, Choi Y, et al. Demarcating the exact midplane of the liver using indocyanine green near-infrared fluorescence imaging during laparoscopic donor hepatectomy. Liver Transpl 2021;27:830-839. 
  33. Lapisatepun W, Hong SK, Hong K, Han ES, Lee JM, Yi NJ, et al. Influence of large grafts weighing ≥ 1000 g on outcome of pure laparoscopic donor right hepatectomy. J Gastrointest Surg 2021;25:1980-1988. 
  34. Tjeertes EK, Hoeks SE, Beks SB, Valentijn TM, Hoofwijk AG, Stolker RJ. Obesity--a risk factor for postoperative complications in general surgery? BMC Anesthesiol 2015;15:112. 
  35. Bergqvist D. Risk of venous thromboembolism in patients undergoing cancer surgery and options for thromboprophylaxis. J Surg Oncol 2007;95:167-174.