Different techniques for harvesting grafts for living donor liver transplantation: A systematic review and meta-analysis

Table 1 Quality of cohort studies evaluated with modified Newcastle-Ottawa scale

Ref.	Case definition	Selection		Definition of controls	Comparability		Outcomes		Quality score
		Represen- tativeness	Selection of controls		Comparable for 1, 2, 3	Comparable for 4, 5	Assessment of outcomes	Integrity of follow-up
Choi et al[16], 2012	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	8
Choi et al[17], 2014	Yes	No	Yes	Yes	No	No	Yes	Yes	5
Makk et al[19], 2014	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	8
Marubashi et al[20], 2013	Yes	No	Yes	Yes	2, 3	4	Yes	Yes	7
Nagai et al[21], 2012	Yes	No	Yes	Yes	1, 3	4	Yes	Yes	7
Samstein et al[22], 2015	Yes	No	Yes	Yes	Yes	No	Yes	Yes	7
Soubrane et al[12], 2006	Yes	No	Yes	Yes	1,3	4	Yes	Yes	7
Suh et al[23], 2015	Yes	No	Yes	Yes	No	No	Yes	Yes	5

1 = gender; 2 = body max index; 3 = graft generation; 4 = age; 5 = haemoglobin.

Table 2 Quality of case-controlled studies evaluated with modified Newcastle-Ottawa scale

Ref.	Case definition	Selection		Definition of controls	Comparability		Outcomes		Quality score
		Represen- tativeness	Selection of controls		Comparable for 1, 2, 3	Comparable for 4, 5	Ascertainment of exposure	Non-response
Baker et al[13], 2009	Yes	No	Yes	Yes	Yes	4	Yes	Yes	7
Kim et al[14], 2009	Yes	No	Yes	Yes	Yes	4	Yes	Yes	7
Kim et al[18], 2011	Yes	No	Yes	Yes	1, 3	Yes	Yes	Yes	6
Thenappan et al[15], 2011	Yes	No	Yes	Yes	No	No	Yes	Yes	7
Zhang et al[24], 2014	Yes	No	Yes	Yes	Yes	4	Yes	Yes	7

1 = gender; 2 = body max index; 3 = graft generation; 4 = age; 5 = haemoglobin.

Table 3 Characteristics of included studies

Ref.	Level of evidence	Patient no.		Left/right	Recipients	TMI	TCI	Matching	Quality score
		MILDH	CLDH
Baker et al[13], 2009	3b	33	33	Right	W	LA	Midline epigastric	1, 2, 3, 4	7
Choi et al[16], 2012	2b	60	90	Right	W/O	LA	Right subcostal	1, 2, 3, 4, 5	8
Choi et al[17], 2014	4	25	484	Right	W/O	HAL or LA	Mercedes-Benz or L-shaped	NA	5
Kim et al[14], 2009	3b	23	23	Right	W	Upper midline	J-shaped	1, 2, 3, 4	7
Kim et al[18], 2011	3b	11	11	Left	W	L	J-shaped or midline	1, 3, 4, 5	7
Makk et al[19], 2014	2b	26	24	Right	W	LA	Right subcostal with midline extension	1, 2, 3, 4, 5	8
Marubashi et al[20], 2013	2b	31	79	Left	W	LA	Mercedes	2, 3, 4	7
Nagai et al[21], 2012	2b	28	30	Right	W	Hal or upper midline	Mercedes	1, 3, 4	7
Samstein et al[22], 2015	2b	22	20	Left	W	L	Midline	1, 2, 3	7
Soubrane et al[12], 2006	2b	16	14	Left	W	L	Subcostal	1, 3, 4	7
Suh et al[23], 2015	4	161	268	Un	W	LA or Upper midline	L-shaped	NA	5
Thenappan et al[15], 2011	3b	15	15	Un	W	LA or Minimally-access	Midline epigastric with subcostal	NA	6
Zhang et al[24], 2014	3b	25	25	Right	W	LA	Right subcostal	1, 2, 3, 4	7

MILDH: Minimally invasive living donor hepatectomy; CLDH: Conventional living donor hepatectomy; Left/right: Graft from left or right liver lobe of donors; Recipients: With or without analyzing recipients; TMI: Type of minimally incisions; TCI: Type of conventional incisions; W: With; W/O: Without; Un: Unclear or not only one kind; L: Laparoscopic approach; LA: Laparoscopy-assisted; HAL: Hand-assisted laparoscopic; Matching: 1 = gender; 2 = body max index; 3 = graft generation; 4 = age; 5 = haemoglobin; NA: No data available.

Table 4 Results of meta-analysis comparison of minimally invasive living donor hepatectomy and conventional living donor hepatectomy

Outcome of interest	Study (n)	MILDH (n)	CLDH (n)	WMD/OR (95%CI)	P value	Study heterogeneity			P value
						I2	df	I2, %
Graft weight (g)	5	123	119	-3.32 (-22.25,15.61)	0.73	6.56	4	39	0.16
Donor outcomes
Operative time (min)	13	476	1116	20.68 (-6.25,47.60)	0.13	147.62	12	92	< 0.01
Estimated blood loss (mL)	12	450	1092	-32.61 (-80.44,15.21)	0.18	61.26	11	82	< 0.01
Hospital cost (dollar)	2	36	36	0.56 (-0.62,1.74)	0.35	4.24	1	76	0.04
Length of hospital stay (d)	10	392	575	-1.25 (-2.35,-0.14)	0.03	99.31	9	91	< 0.01
Post complications	12	451	632	0.62 (0.44,0.89)	0.009	4.40	11	0	0.96
Analgesic use (h)	5	139	167	-7.97 (-14.06,-1.87)	0.01	7.50	4	47	0.11
Liver function
Post AST peak (IU/L)	7	334	471	6.41 (-3.79.16.60)	0.22	13.60	6	56	0.03
Post ALT peak (IU/L)	8	350	485	11.86 (-10.84,34.57)	0.31	15.39	7	55	0.03
Post TB peak (mg/dL)	7	324	461	-0.10 (-0.26,0.06)	0.21	2.10	6	0	0.91
Recipient outcomes
Liver function
Post AST peak (IU/L)	3	59	59	-28.73 (-86.76,29.31)	0.33	0.90	2	0	0.64
Post ALT peak (IU/L)	3	59	59	-29.98 (-87.65,27.7)	0.31	0.31	2	0	0.86
Post TB peak (mg/dL)	3	59	59	-0.96 (-2.57,0.65)	0.24	1.26	2	0	0.53
Surviving	3			0.96 (0.27,3.47)	0.95	0.11	2	0	0.95
Post complications	6	272	375	0.93 (0.66,1.31)	0.68	3.28	5	0	0.66

MILDH: Minimally invasive living donor hepatectomy; CLDH: Conventional living donor hepatectomy; WMD/OR: Weight mean difference/odds ratio; df: Degree of freedom; Post: Postoperative.