Minimal Surgical Manpower for Living Donor Liver Transplantation
Background: Living donor liver transplantation (LDLT) is widely performed with good outcomes in the current era of improved surgical techniques. However, few studies have addressed how many human resources are required in the surgery itself. This study aimed to introduce how to perform LDLT with min...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/15/4292 |
| _version_ | 1797432832103022592 |
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| author | Seoung Hoon Kim Jang Ho Park Byoung Ho An |
| author_facet | Seoung Hoon Kim Jang Ho Park Byoung Ho An |
| author_sort | Seoung Hoon Kim |
| collection | DOAJ |
| description | Background: Living donor liver transplantation (LDLT) is widely performed with good outcomes in the current era of improved surgical techniques. However, few studies have addressed how many human resources are required in the surgery itself. This study aimed to introduce how to perform LDLT with minimal manpower and evaluate the outcomes in adult patients. Methods: The main surgical procedures of donor and recipient operations of LDLT were performed by a single specialist surgeon who led a team of minimal manpower that only included one fellow, one resident, one intern, and three nurses. He also provided postsurgical care and followed up all the patients as a primary care physician. The outcomes were analyzed from the standpoints of the feasibility and acceptability. Results: Between November 2018 and February 2020, a total of 47 patients underwent LDLT. Ten patients had ABO-incompatible donors. The median age of the overall recipients was 57 years old (36–71); 37 patients (78.7%) were male. The MELD score was 10 (6–40), and the main etiologies were hepatic malignancy (38 patients or 80.9%) and liver failure (9 patients or 19.1%). The median age of the overall donors was 34 years old (19–62); 22 patients (46.8%) were male. All the graft types were right liver except for one case of extended right liver with middle hepatic vein. All donors had an uneventful recovery with no complications. There was one intraoperative mortality due to cardiac arrest after reperfusion in one recipient. Hepatic artery thrombosis was developed in 5 (10.6%) recipients. An acute rejection episode occurred in one patient. The median follow-up period for all the patients was 32.9 months (range, 24.7–39.8). Biliary complications were developed in 11 (23.4%) recipients. In total, 7 (15%) patients died, including 1 intraoperative mortality, 5 from cancer recurrence, and 1 from intracranial hemorrhage. The 1-, 2-, and 3-year overall survival rates in the recipient group were 91.5%, 87.2%, and 85.1%, respectively. Conclusions: LDLT with minimal surgical manpower is feasible under the supervision of a single expert surgeon who has the capacity for all the main surgical procedures in both donor and recipient operations without compromising the outcomes in the present era of advanced surgical management. |
| first_indexed | 2024-03-09T10:07:20Z |
| format | Article |
| id | doaj.art-4e797db52b5e417783a7d0716504791c |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T10:07:20Z |
| publishDate | 2022-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-4e797db52b5e417783a7d0716504791c2023-12-01T22:59:07ZengMDPI AGJournal of Clinical Medicine2077-03832022-07-011115429210.3390/jcm11154292Minimal Surgical Manpower for Living Donor Liver TransplantationSeoung Hoon Kim0Jang Ho Park1Byoung Ho An2National Cancer Center, Goyang-si 10408, Gyeonggi-do, KoreaNational Cancer Center, Goyang-si 10408, Gyeonggi-do, KoreaNational Cancer Center, Goyang-si 10408, Gyeonggi-do, KoreaBackground: Living donor liver transplantation (LDLT) is widely performed with good outcomes in the current era of improved surgical techniques. However, few studies have addressed how many human resources are required in the surgery itself. This study aimed to introduce how to perform LDLT with minimal manpower and evaluate the outcomes in adult patients. Methods: The main surgical procedures of donor and recipient operations of LDLT were performed by a single specialist surgeon who led a team of minimal manpower that only included one fellow, one resident, one intern, and three nurses. He also provided postsurgical care and followed up all the patients as a primary care physician. The outcomes were analyzed from the standpoints of the feasibility and acceptability. Results: Between November 2018 and February 2020, a total of 47 patients underwent LDLT. Ten patients had ABO-incompatible donors. The median age of the overall recipients was 57 years old (36–71); 37 patients (78.7%) were male. The MELD score was 10 (6–40), and the main etiologies were hepatic malignancy (38 patients or 80.9%) and liver failure (9 patients or 19.1%). The median age of the overall donors was 34 years old (19–62); 22 patients (46.8%) were male. All the graft types were right liver except for one case of extended right liver with middle hepatic vein. All donors had an uneventful recovery with no complications. There was one intraoperative mortality due to cardiac arrest after reperfusion in one recipient. Hepatic artery thrombosis was developed in 5 (10.6%) recipients. An acute rejection episode occurred in one patient. The median follow-up period for all the patients was 32.9 months (range, 24.7–39.8). Biliary complications were developed in 11 (23.4%) recipients. In total, 7 (15%) patients died, including 1 intraoperative mortality, 5 from cancer recurrence, and 1 from intracranial hemorrhage. The 1-, 2-, and 3-year overall survival rates in the recipient group were 91.5%, 87.2%, and 85.1%, respectively. Conclusions: LDLT with minimal surgical manpower is feasible under the supervision of a single expert surgeon who has the capacity for all the main surgical procedures in both donor and recipient operations without compromising the outcomes in the present era of advanced surgical management.https://www.mdpi.com/2077-0383/11/15/4292living donor liver transplantationminimal manpower |
| spellingShingle | Seoung Hoon Kim Jang Ho Park Byoung Ho An Minimal Surgical Manpower for Living Donor Liver Transplantation Journal of Clinical Medicine living donor liver transplantation minimal manpower |
| title | Minimal Surgical Manpower for Living Donor Liver Transplantation |
| title_full | Minimal Surgical Manpower for Living Donor Liver Transplantation |
| title_fullStr | Minimal Surgical Manpower for Living Donor Liver Transplantation |
| title_full_unstemmed | Minimal Surgical Manpower for Living Donor Liver Transplantation |
| title_short | Minimal Surgical Manpower for Living Donor Liver Transplantation |
| title_sort | minimal surgical manpower for living donor liver transplantation |
| topic | living donor liver transplantation minimal manpower |
| url | https://www.mdpi.com/2077-0383/11/15/4292 |
| work_keys_str_mv | AT seounghoonkim minimalsurgicalmanpowerforlivingdonorlivertransplantation AT janghopark minimalsurgicalmanpowerforlivingdonorlivertransplantation AT byounghoan minimalsurgicalmanpowerforlivingdonorlivertransplantation |