Systematic review and meta-analysis of open versus laparoscopy-assisted versus pure laparoscopic versus robotic living donor hepatectomy. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society The value of minimally invasive approaches for living donor hepatectomy remains unclear. Our aim was to compare the donor outcomes after open versus laparoscopy-assisted versus pure laparoscopic versus robotic living donor hepatectomy (OLDH vs. LALDH vs. PLLDH vs. RLDH). A systematic literature review of the MEDLINE, Cochrane Library, Embase, and Scopus databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (up to December 8, 2021). Random-effects meta-analyses were performed separately for minor and major living donor hepatectomy. The risk of bias in nonrandomized studies was assessed using the Newcastle-Ottawa Scale. A total of 31 studies were included. There was no difference in donor outcomes after OLDH versus LALDH for major hepatectomy. However, PLLDH was associated with decreased estimated blood loss, length of stay (LOS), and overall complications versus OLDH for minor and major hepatectomy, but also with increased operative time for major hepatectomy. PLLDH was associated with decreased LOS versus LALDH for major hepatectomy. RLDH was associated with decreased LOS but with increased operative time versus OLDH for major hepatectomy. The scarcity of studies comparing RLDH versus LALDH/PLLDH did not allow us to meta-analyze donor outcomes for that comparison. There seems to be a marginal benefit in estimated blood loss and/or LOS in favor of PLLDH and RLDH. The complexity of these procedures limits them to transplant centers with high volume and experience. Future studies should investigate self-reported donor experience and the associated economic costs of these approaches. 10.1097/LVT.0000000000000115

Living well or not? Quality of life of parental living liver donors: A cross-sectional study. Journal of clinical nursing AIM:The aim of this study was to gain comprehensive insight into the quality of life of parental living liver donors after liver donation. BACKGROUND:Several studies reported good quality of life of living liver donors with the SF-36 scale. Care demand from the recipient and responsibility of being parent might make a difference in parental donors' personal experienced quality of life after transplantation surgery. METHODS:It is a cross-sectional study. The parental donors' demographics, clinical data and post-donation complications were obtained. Quality of life was assessed using the Medical Outcomes Study SF-36 and the Quality of Life Scale of Living Organ Donors-Common Module. PATIENT OR PUBLIC CONTRIBUTION:The enrolled participants were contacted by electronic questionnaires and telephonic interview. RESULTS:A total of 345 parental donors were included, with recruited period ranging from 3 to 85 months post-donation. 8.1% of donors had post-operative complications, mostly classified as Clavien grade II. Donors' general quality of life was higher than the Chinese general norm. Issues related to surgical incision, fatigue, worries about income and personal health, effects on work capability, increased medical expenses and difficult reimbursement and suspected donation decision were the prominent problems among donors. Mother-son relationship (OR = 1.87) and equal or less than 2 years after donation (OR = 3.08) were the influencing factors for poor physical quality of life, while unmarried status (e.g. divorced or widowed) was found negatively associated with mental quality of life (adjusted OR = 3.61). CONCLUSIONS:General health among parental donors is good but those female, unmarried and near post-donation might in low life quality. Incision, fatigue, finance, reimbursement and donation decision are prominent problems. RELEVANCE TO CLINICAL PRACTICE:Post-donation care of living donors should cover social and financial domain besides physical and mental dimension. Providing follow-up care and counselling is necessary to ensure their life quality. 10.1111/jocn.16774

Long-term risk of a fatty liver in liver donors. Annals of gastroenterological surgery Aim:Approximately 30 years have passed since the first experience of living donor liver transplantation. The time to evaluate the long-term safety of living donors has been fulfilled. Meanwhile, nonalcoholic fatty liver disease is increasingly common and a critical problem. The aim of this study was to evaluate the safety of living donor, focusing on fatty liver postdonation hepatectomy. Methods:Living donors ( = 212, 1997-2019) were evaluated by computed tomography (CT) at >1-year postdonation. A liver to spleen (L/S) ratio of <1.1 was defined as fatty liver. Results:Among 212 living liver donors, 30 (14.2%) detected fatty liver at 5.3 ± 4.2 years postdonation. The cumulative incidence rates of fatty liver were 3.1%, 12.1%, 22.1%, and 27.7% at 2, 5, 10, and 15 years postdonation, respectively. Of 30 subjects who developed fatty liver, 18 (60%) displayed a severe steatosis (L/S ratio <0.9). Five (16.7%) had a prior history of excessive alcohol abuse. More than 30% developed metabolic syndrome including obesity, hyperlipidemia, and diabetes. Although six (20%) had a Fib-4 index of >1.3, which included a case with a Fib-4 index of >2.67, no significant increased Fib-4 index was observed in the subjects with fatty liver as compared to those without fatty liver ( 0.66). The independent predictive risk factors for developing fatty liver were male sex, pediatric recipient, and higher body mass index (>25) at donation. Conclusion:Living donors with risk factors for developing fatty liver should be carefully followed-up for the prevention and management of metabolic syndrome. 10.1002/ags3.12658