LDLT-donor: Impact of complex bilio-vascular donor anatomy on donor and recipient morbidity in adult LDLT

ABSTRACT

Rationale With increasing experience, and widespread application of LDLT worldwide, experienced LDLT centers now accept right or left lobe donors with complex bilio-vascular anatomy. Though there are a few reports from high volume centers that this may not have an impact on graft or recipient outcome, the true impact in terms of vascular and biliary complications in the recipient and the donor is not well studied. Moreover, accepting these donors may also have an impact on donor morbidity, with possible higher incidence of biliary, vascular complications, re-explorations etc. The true implication would probably be identified if we were to not only analyze the absolute incidence, but also the incidence compared to a cohort of donors and recipients with standard vascular and biliary anatomy. This can probably done only in a multicenter study, where there are different donor acceptance criteria, and probably slightly variant surgical techniques. Aims: Primary objective -This study aims to determine the differences in incidence of bilio-vascular complications and morbidity in recipients of LDLT receiving grafts from donors with complex bilio-vascular anatomy, compared to those receiving grafts with single artery, portal vein, bile duct. Secondary objectives -To determine whether presence of complex bilio-vascular anatomy has an impact on donor complications, and adds to donor morbidity. To determine whether number (of graft artery/PV/ducts), type (according to classification of bilio-vascular donor anatomy), or type of anastomoses (using loupes vs. microscope for artery and bile duct, plasty with straight extension vs. Y graft in PV, duct to duct vs. Roux for multiple ducts etc.) determine incidence of complications. To determine whether complications have an impact on long term graft and patient outcomes. Update While the two centers Medanta-The Medicity, India, and Asan Medical Center, South Korea have already started accumulating data on the subject in the designed form, we are awaiting Ethical Committee approval for the multicenter study. This has been delayed given the COVID pandemic. We have already received applications from 4 other centers Icahn School of Medicine at Mount Sinai, RMTI, NY, USA, National Medical Research Center of transplantology and Artificial Organs named after V.I. Shumakov/ Surgical Department #2 (Liver Transplantation), National Medical Research Center of transplantology and Artificial Organs named after V.I. Shumakov/ Surgical Department #2 (Liver Transplantation), and University of Unimore, Modena, Italy. We will accept these other centers for the study as soon as we have IRB Approval.