Effect of Donor Warm Ischemia Time During Graft Extraction in Right Lobe Robotic Donor Hepatectomy on Recipient Outcomes - A Propensity Score Matched Analysis.

ABSTRACT

One of the concerns specific to minimally invasive donor hepatectomy(MIDH) is the prolonged time required for graft extraction after completion of the donor hepatectomy(donor warm ischemic time(DWIT)). There has never been an objective evaluation of MIDH-DWIT on allograft function in living donor liver transplantation(LDLT).We evaluated the effect of DWIT following robotic donor hepatectomy(RDH) on recipient outcomes and compared them with a matched cohort of open donor hepatectomy (ODH).Demographic, perioperative and recipient's post-operative outcome data for all right lobe(RL)-RDH performed between September 2019 and July 2023 was analysed and compared with a propensity-score matched cohort(11) of RL-ODH from the same time period. Of a total of 103 RL-RDH and 446 RL-ODH, unmatched and Propensity-score matched analysis(11) revealed a significantly longer DWIT in the RDH group as compared to the ODH group (9.33±3.95 Vs 2.87±2.13, p<0.0001). This did not translate into any difference in the rates of early allograft dysfunction (EAD), biliary complications(BC), major morbidity or overall 1-& 3-month survival. ROC curve analysis threshold for DWIT-EAD was 9min (AUROC0.67,sensitivity=80%,specificity=53.8%).We show that prolonged DWIT within an acceptable range in RDH does not have deleterious effects on short-term recipient outcomes. Further long-term studies are required to confirm our findings especially with regards to non-anastomotic BC.