Introduction: In living donor liver transplantation (LDLT) the safety of the live donor is of paramount importance. Despite all efforts, the morbidity rates approach 20%, with most Clavien-Dindo 3a/3b complications relating to bile leak/collections or bleeding. In some LDLT centres, “White Test” (WT) is carried out by trans-cystic injection of propofol after completion of donor hepatectomy to detect bile leaks, and repair instantly. The study aims to identify if WT helps in living donor hepatectomy.
Methods: Retrospective review of 150 living donor hepatectomies with white test (WT) at Air Force Hospital, Egypt (2017 to 2021) with 108 living donor hepatectomies with no white test (NWT) at Leeds Teaching Hospitals, UK (2007 to 2021). Primary outcomes were bile leak rate and intervention for bile leak.
Results: There was no difference in mean donor age between the two groups (34 years in WT group vs. 32 years in NWT group), but there were 91% male donors in WT group compared to only 47% in NWT group. In the WT group, there were 128 (85%) right lobe grafts, 14 left lobe grafts (10%) and 8 left lateral grafts (5%). In the NWT group, there were 36 (33%) right lobe grafts, 8 (7%) left lobe grafts and 64 (60%) left lateral grafts. Two patients (1.3%) in WT group needed percutaneous drain insertion for bile leak and both were right lobe donors. Similarly, two patients (1.8%) in NWT group had bile leak, one managed with leaving intra-op surgical drain longer (LLS donor) and one needing percutaneous drain insertion (right lobe donor). There were no reexploration in both group for bile leak. The median length of stay in WT group was 11 days, compared to 6 days in NWT group.
Conclusions: Although there was no difference in bile leak incidence between the two-study group, white test may have helped in detecting intraoperative bile leaks in majority right lobe donors (85%) in the Egyptian cohort and hence demonstrating a lower rate, when compared to the published rates from other LDLT centres.