When is it safe for the liver donor to be discharged home and prevent unnecessary re‐hospitalizations? – A systematic review of the literature and expert panel recommendations

Abstract

Few data are available on discharge criteria after living liver donation (LLD). To identify the features for fit for discharge checklist after LLD to prevent unnecessary re-hospitalizations and to provide international expert recommendations. Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. The critical outcomes included were complications rates and liver function (defined by elevated bilirubin and INR) (CRD42021260725). Total 57/1710 studies were included in qualitative analysis and 28/57 on the final analysis. No randomized controlled trials were identified. The complications rate was reported in 20/28 studies and ranged from 7.8% to 71.2%. Post hepatectomy liver function was reported in 13 studies. The Quality of Evidence (QoE) was Low and Very-Low for complications rate and liver function test, respectively. Monitoring and prevention of donor complicationsshould be crucial in decision making of discharge.Pain and dietcontrol, removal of all drains and catheters, deep venous thrombosis prophylaxis, and useroutine imaging (CT scan or liver ultrasound) before discharge should be included as fit for discharge checklist (QoE; Low | GRADE of recommendation; Strong). Transient Impaired liver function (defined by elevated bilirubin and INR), a prognostic marker of outcome after liver resection,usually occurs after donor right hepatectomy and should be monitored.Improving trends forbilirubin and INR value should be observed by day5post hepatectomyand be included in thefit for discharge checklist. (QoE; Very-Low | GRADE; Strong).