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Introduction: The current study aimed to assess the safety of early drain removal after live donor hepatectomy (LDH). Methods: One hundred eight consecutive donors who met the inclusion criteria were randomized to early drain removal (EDR — postoperative day (POD) 3 — if serous and the drain bilirubin level was less than 3 mg/dl — "3 × 3" rule) and routine drain removal (RDR — drain output serous and less than 100 ml). The primary outcome was to compare the safety. The secondary outcome was to compare the postoperative morbidity. Results: Preoperative, intraoperative, and postoperative parameters except for the timing of drain removal were comparable. EDR was feasible in 46 out of 54 donors (85.14%) and none required re-intervention after EDR. There was significantly better pain relief with EDR (p = 0.00). Overall complications, pulmonary complications, and hospital stay were comparable on intention-to-treat analysis. However, pulmonary complications (EDR — 1.9% vs RDR — 16.3% P = 0.030), overall complications (18.8% vs 36.3%, P = 0.043), and hospital stay (8 vs 9, P = 0.014) were more in the RDR group on per treatment analysis. Bile leaks were seen in three donors (3.7% in the EDR group vs 1.9% in RDR, P = 0.558), and none of them required endo-biliary interventions. Re-exploration for intestinal obstruction was required for 3 donors in RDR (0% vs 5.7%; p = 0.079). Conclusion: EDR by the "3 × 3" rule after LDH is safe and associated with better pain relief. On per treatment analysis, EDR was associated with significantly less hospital stay and lower pulmonary and overall complications. Clinical trial registry: Clinical Trials.gov — NCT04504487. [ABSTRACT FROM AUTHOR]

Background: Hepatic artery–related complications (HARC) after live donor liver transplantation (LDLT) is associated with high morbidity and mortality rate. Methods: Prospectively maintained data from July 2011 to September 2020 was analyzed for etiology, detection, management, and outcome of HARC. Results: Six hundred fifty-seven LDLT (adult 572/pediatrics 85) were performed during the study period. Twenty-one (3.2%) patient developed HARC; 16 (2.4%) hepatic artery thrombosis (HAT) and 5 (0.76%) non-thrombotic hepatic artery complication (NTHAC). Ninety percent (19/21) HARC were asymptomatic and detected on protocol Doppler. Median time to detection was day 4 (range − 1 to 35), which included 18 early (within 7 days) vs 3 late incidents. Only one pediatric patient had HAT. Seven patients underwent surgical revascularization, 11 had endovascular intervention and 3 with attenuated flow required only systemic anticoagulation. All NTHAC survived without any sequelae. Revascularization was successful in 81% (13/16) with HAT. Biliary complications were seen in 5 (23.8%); four were managed successfully. Overall mortality was 14.8% (3/21). The 1-year and 5-year survival were similar to those who did not develop HARC (80.9% vs 84.2%, p = 0.27 and 71.4% vs 75.19%, p = 0.36 respectively) but biliary complications were significantly higher (23.8% vs 14.2%, p = 0.03). On multivariate analysis, clockwise technique of arterial reconstruction was associated with decreased risk of HAT (1.7% vs 4.1% (p value − 0.003)). Conclusion: Technical refinement, early detection, and revascularization can achieve good outcome in patients with HARC after LDLT. [ABSTRACT FROM AUTHOR]

Introduction: The duration of perioperative antibiotic prophylaxis following live liver donor hepatectomy (LDH) is not known. Methods: This is a double‐blind equivalence trial. All consecutive LDH were randomized into: group A (three doses) and group B (nine doses) of perioperative antibiotics (piperacillin + tazobactam − 4.5 g intravenous) at fixed 8 hourly intervals. Primary end point was incidence of infective complications as per CDC (Centers for Disease Control and Prevention) criteria. Secondary end points were liver function tests, total leukocyte count, international normalized ratio, hospital stay, morbidity, and cost analysis. Results: One hundred and twenty‐six LDHs were enrolled. A total of 19.8% (n = 25) experienced postoperative complications, 11 (17.7%) in group A and 14 (21.9%) in group B (P =.561). Infective complications were seen in 11 donors (8.1%), five in group A and six in group B (P =.79). A total of 8.1% of donors required continuation/up‐gradation of antibiotics in group A and 9.4% in group B. Return to soft diet was delayed in group B (P =.039). Median hospital stay and cost were similar. Conclusion: Three doses of perioperative antibiotic are equally effective in preventing infective complications. [ABSTRACT FROM AUTHOR]