Risk factors for morbidity in both donor and recipient following minimally invasive donor hepatectomy: a systematic review.

Background: Minimally invasive donor hepatectomy (MIDH), including laparoscopic, laparoscopic-assisted, and robotic donor hepatectomy, is an evolving technique in living donor liver transplantation, but its technical complexity presents potential risks for both donors and recipients. This study purposes to systematically review and identify key risk factors for donor and recipient morbidity after MIDH.

Methods: A systematic search of electronic databases was performed to identify studies published between January 2001 and December 2024 that reported significant risk factors for donor and recipient complications after MIDH. Risk factors for overall or major complications, biliary complications (bile leak or biliary stricture), or open conversion were summarized using odds ratios or hazard ratios with 95% confidence intervals derived from multivariate analysis.

Results: In total, eight studies reported significant risk factors for donor or recipient after MIDH. Risk factors for donor complications included unfavorable anatomical characteristics (short hepatic ducts, multiple hepatic ducts/arteries/veins, and large graft) and operative factors (increased operative time and blood loss). Conversion from laparoscopic to open was related to high BMI. Recipient risk factors included biliary variations, portal vein thrombosis, hepaticojejunostomy, prolonged operative time, massive transfusion, and high MELD scores. Robotic surgery was linked to favorable donor and recipient outcomes.

Conclusion: Risk factors for donor and recipient morbidity after MIDH include anatomical, operative, procedural, donor, and recipient factors. Notably, biliary variation of graft is key contributor for both donor and recipient morbidity. Given the limited studies on risk factors, multicenter studies with larger sample sizes are essential to validate these findings.