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Living donor liver transplantation (LDLT) is flourishing in localities where deceased organ donation is prohibited or not favored due to religious, cultural, or legal issues. (1) It is hypothesized that LDLT has an immunological advantage over deceased donor liver transplantation (DDLT) due to the fact that most LDLT is done among genetically related (GR) donor-recipient pairs.(2) However, the difference in ischemia time, the quality of the graft, and the age of the donor may be confounding factors that make the comparison inaccurate.(2,3) To understand the impact of genetic relation on the outcome of liver transplantation, LDLT is a perfect model because grafts are procured from both GR and genetically unrelated (GUR) donors.Unlike renal transplantation, current practice does not consider human leukocyte antigen (HLA) matching as a basic step in liver transplantation based on the apparent absence of hyperacute rejection and the infrequent early graft loss from rejection.(4) However, its impact on graft survival, immunosuppressive regimen, and patient outcome have been warranted in further research.(5) Multiple studies investigated the effect of HLA mismatching on graft and recipient outcomes.(5-7)

Introduction: Living donor liver transplantation (LDLT) is a complex surgery with high risk for massive bleeding and blood component transfusion. This retrospective study investigated the effect of adopting ROTEM based transfusion algorithm on blood products transfusion practice among LDLT recipients and the effect of this change on patient outcome. Material and methods: Data of 216 patients with predicted intraoperative massive bleeding (blood loss ≥70 ml blood/kg, or blood loss > 150 ml/min with hemodynamic affection with continuing need for transfusion) were collected from our database. Patients were divided into two groups according to transfusion protocol applied; Pre-ROTEM group (n = 95), ROTEM group (n = 121). Basal characteristics, blood component transfusion, graft outcome and patient outcome (28-day mortality and one-year mortality) were compared between the two groups. Results: Transfused packed red blood cells (PRBCs) units, fresh frozen plasma (FFP) units, and application of massive transfusion protocol (MTP) were significantly lower in the ROTEM group compared to pre-ROTEM group [8(7) vs 4.5(5), p < 0.01, 12.5(4) vs 5.6(3), p < 0.001, 29% vs 20%, p < 0.005 respectively]. The survival distributions for the two studied groups showed no statistically significant difference, p < 0.46. Conclusions: ROTEM based transfusion algorithms applied in LDLT decreased blood component transfusion and enhanced early graft function.

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Background:Transversus abdominis plane (TAP) block is a promising technique for analgesia after abdominal surgery. This prospective, randomized controlled trial assessed the effect of adding dexmedetomidine to bupivacaine in TAP block for donor hepatectomy. We hypothesized that this would improve postoperative morphine consumption and reduce analgesia related complication and inflammation.Methods:A total of 50 donor hepatectomy were enrolled in this study. Patients divided into two equal groups according to drugs used for TAP block. Group (B) received 20 ml of bupivacaine hydrochloride 0.25%, Group (BD) received 20 ml of bupivacaine hydrochloride 0.25% and 0.3 μg/kg dexmedetomidine, on both sides at the end of surgery and every 8 h for 48 h at right side only through inserted catheter. Primary outcome objective was morphine consumption at first 72 h. Secondary outcome objectives were morphine requirement, numbers of intake, time to first intake, pain score numerical analog scale (NAS), postoperative analgesia related complications, recovery of intestinal motility, and inflammatory markers.Results:Data were analyzed, rescue morphine analgesia was significantly lower in (BD) group compared with (B) groups as considering total morphine consumption (B 4 ± 1.9, BD 1.5 ± 0.5, P = 0.03), numbers of morphine intake (P = 0.04), morphine requirement (P = 0.03), and first time of analgesia intake (P = 0.04). NAS was significantly lower in group (BD) compared with group (B) group in the first 12 h (NAS 0 - P = 0.001, NAS 1 - P = 0.03). Adding dexmedetomidine improved gut motility, first oral intake without detectable anti-inflammatory effect.Conclusion:Adding dexmedetomidine to bupivacine in a surgically inserted catheter for TAP block in donor hepatectomy reduced morphine consumption without detectable anti-inflammatory effect.