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Meta-Analysis
. 2017 May 28;23(20):3730-3743.
doi: 10.3748/wjg.v23.i20.3730.

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

Hui Li  1 , Jun-Bin Zhang  1 , Xiao-Long Chen  1 , Lei Fan  1 , Li Wang  1 , Shi-Hui Li  1 , Qiao-Lan Zheng  1 , Xiao-Ming Wang  1 , Yang Yang  1 , Gui-Hua Chen  1 , Gen-Shu Wang  1
Affiliations
Meta-Analysis

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

Hui Li et al. World J Gastroenterol. .

Abstract

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.

Keywords: Conventional invasive approaches; Graft harvesting; Living donor hepatectomy; Meta-analysis; Minimally invasive techniques.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this report.

Figures

Figure 1
Figure 1
Flow diagram of study identification, inclusion and exclusion.
Figure 2
Figure 2
Forest plots and meta-analysis of intraoperative outcomes of donors.
Figure 3
Figure 3
Forest plot and meta-analysis of postoperative biliary complications for donors.
Figure 4
Figure 4
Forest plots and meta-analysis of postoperative outcomes of donors.
Figure 5
Figure 5
Forest plots and meta-analysis of postoperative liver function of donors.
Figure 6
Figure 6
Forest plot and meta-analysis of postoperative biliary complications for recipients.
Figure 7
Figure 7
Forest plots and meta-analysis of postoperative outcomes of recipients.
Figure 8
Figure 8
Forest plot and meta-analysis of postoperative complication rates for donors.
Figure 9
Figure 9
Forest plot and meta-analysis of operative time for donors.
Figure 10
Figure 10
Forest plot and meta-analysis of estimated blood loss for donors.
Figure 11
Figure 11
Funnel plot of postoperative complication rates.
See this image and copyright information in PMC

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