Early drain removal after live liver donor hepatectomy is safe - A randomized control trial

Abstract INTRODUCTION: The aim of current study was to assess safety of early drain removal after live donor hepatectomy (LDH). METHODS: 108 consecutive donors who met the inclusion criteria, were randomized to Early Drain Removal (EDR – post operative day (POD) 3 - if serous and the drain bilirubin level was less than 3 times of serum bilirubin - “3x3” rule) and Routine Drain Removal (RDR – drain output serous and less than 100ml). Primary outcome was to compare the safety. Secondary outcomes was to compare the post-operative morbidity. RESULTS: Pre-operative, intra-operative and postoperative parameters except for 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 comparableon 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 RDR group on per treatment analysis. Bile leaks were seen in three donors (3.7% in EDR group Vs RDR 1.9% in P=0.558), none of them required endobiliary interventions. Re-Exploration for intestinal obstruction was required for 3 donors in RDR (0% vs 5.7%; p-0.079). CONCLUSION: EDR by “3x3” rule after LDH is safe and associated with significantly better pain relief. On per treatment analysis, EDR was associated with significantly less hospital stay, pulmonary and overall complications. Clinical Trial Registry: Clinical Trials.gov - NCT04504487.