Comment on Respiratory Complications Among Living Liver Donors: A Single-Center Retrospective Observational Study

Abstract

Dear Editor; We read with great interest the recent article ''Respiratory Complications Among Living Liver Donors: A Single-Center Retrospective Observational Study'' published by Elbeialy and colleagues.[1] The authors stated that despite the low incidence of significant respiratory complications among their living liver donor cohort, close monitoring and early management are essential to achieve better prognosis, especially in donors older than 35 years or those with previous surgery. We would like to draw attention to a few points. Authors state that they routinely use conventional angiography to evaluate the suitability of the living liver donor candidates. In the earlier times of living donor liver transplantation, the imaging techniques had an insufficient quality and conventional angiography was routinely used to avoid unnecessary laparotomy. However, in the last decade, there is a great number of advancements in the accuracy and quality of the non-invasive imaging techniques that resulted in the abandonment of the conventional angiography for the evaluation of the living liver donors.[2] Currently, conventional angiography is only used for the evaluation of vascular anatomy under certain exceptional conditions. In our institute, we use conventional angiography in less than 0.1 % of living liver donor candidates. Similarly, if preoperative ultrasonography, dynamic computerized tomography, and dynamic magnetic resonance imaging are performed appropriately, the fibrosis and hepatosteatosis can be evaluated accurately and occasionally there will be nor need for preoperative liver biopsy. In recent years, transient elastography (Fibroscan) can help determine the texture and steatosis of the liver, and together with using a specific formula, steatosis rates can be determined which is comparable with the histopathological evaluation.[3,4] The authors have stated that they have used PASS software to calculate the sample size of 124 patients. In our opinion, there is no need for sample size and power analysis calculation in the present study because the authors have included all living liver donors’ in the designated period which makes alpha value to be 0.05 at the minimum and the power would be 100%. If the authors were to use a statistical method, they should have performed propensity score matching analysis on the 10 patients with complications by choosing a 1:2 matched control group with similar demographic and clinical characteristics. This approach would Please cite this article as ”Akbulut S. Comment on Respiratory Complications Among Living Liver Donors: A Single-Center Retrospective Observational Study. J Inonu Liver Transpl Inst 2023;1(2):79–80”. Sami Akbulut