Postoperative health status and quality of life after pure laparoscopic donor hepatectomy for living donor liver transplantation
Chan Woo Cho1, Gyu-Seong Choi2, Jong Man Kim2, Kyeong Sik Kim4, Jinsoo Rhu2, Choon Hyuck D Kwon3, Jae-Won Joh2.
1Surgery, Yeungnam University College of Medicine, Daegu, Korea; 2Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 3General Surgery, Digestive Disease & Surgery Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States; 4General Surgery, Hanyang University Medical Center, Seoul, Korea
Background: Laparoscopic donor hepatectomy (LDH) for living donor liver transplantation has been performed in several specialized institutes. Surgical outcomes of LDH have shown comparable results to open donor hepatectomy (ODH), but the quality of life (QOL) after LDH is not known. This prospective questionnaire-based study was performed to assess health status and QOL of live liver donors before and after donor hepatectomy (DH).
Material and Methods: From May 2017 to February 2020, 70 liver donors who underwent donor hepatectomy (DH) were enrolled, and questionnaire items such as Enhanced Recovery after Surgery (ERAS) mobility scale (EMS), Body Image Questionnaire (BIQ), and EQ-5D-3L were examined up to one year after DH to evaluate postoperative recovery, body image satisfaction, and health status, respectively. During the study period, 45 LDH donors and two ODH donors were finally fully evaluated (Figure 1).
Results: Two patients in the OLH group were discharged on POD 8 and POD 10, respectively, with neither of the two achieving the level of being independently mobile (EMS ≥8). On the contrary, patients in the LDH group were considered independently mobile from POD 5 based on the mean EMS of 45 patients. The LDH group had a significantly higher mean EMS than the ODH group on POD 5 and 7 (P = 0.011, and P = 0.004, respectively, Figure 2).
Body image score of the LDH group was significantly higher than that of the ODH group at one month after DH (17.8 vs. 15.0, P = 0.017). EQ-5D-3L index value and EQ-5D-3L VAS were not different from preoperative values at six months (P = 0.059) and one month (P = 0.217), respectively (Figure 3).
Conclusions: Donors undergoing LDH showed faster (within a month) mobility recovery and body image satisfaction to the level of preoperative status than donors undergoing ODH. In the evaluation of QOL using EQ-5D, donors who underwent LDH recovered to preoperative health status within six months, in accordance with previous studies of donors with ODH. A multicentre prospective study will be needed to compare the LDH and ODH groups.
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