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Krishna P, Rammohan A, Rajalingam R, Narasimhan G, Cherukuru R, Sachan D, Rajakumar A, Kaliamoorthy I, Reddy MS, Rela M. Propensity score matched analysis and risk stratification of donors with G6PD deficiency in living donor liver transplantation. Hepatol Int 2024; 18:265-272. [PMID: 37700142 DOI: 10.1007/s12072-023-10583-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/16/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Glucose 6 phosphate dehydrogenase (G6PD) deficiency (G6PDd) can trigger hemolysis following surgical stress. Differentiating G6PDd-related post-operative hemolytic episodes (PHE) and post-hepatectomy liver failure may be challenging especially in living donors where donor safety is paramount. We analysed outcomes of our cohort of G6PDd liver donors. METHODS G6PDd individuals with no evidence of hemolysis were considered as living donors if there was no alternative family donor. Outcomes of G6PDd donors undergoing left lateral/left lobe donation (Group LL) and right lobe donation (Group RL) were compared with non-G6PDd donors matched in a 1:3 ratio using propensity score matching. RESULTS 59 G6PDd donors (5.8% of 1011) underwent living donor hepatectomy (LiDH) during the study period. LL-G6PDd donors (22.37%) had higher post-operative peak bilirubin level compared to matched controls, but no difference in morbidity or need for post-operative blood transfusion.RL-G6PDd donors (37.63%) had higher peak bilirubin level, morbidity (16.2% vs. 3.6%, p = 0.017) and more post-operative blood transfusion (21.6% vs. 6.4%, p = 0.023) as compared to matched non-G6PDd cohort. Four RL-G6PDd donors (10.8%) developed PHE. Low G6PD activity (15% vs. 40%, p = 0.034) and lower future liver remnant (FLR) (34.3% vs. 37.8%, p = 0.05) were identified as risk factors for PHE. CONCLUSION We report the largest to-date series of G6PDd individuals undergoing LiDH and confirm the safety of LL donation in G6PDd. Our analysis identifies specific risk factors for PHE and suggests that right lobe LiDH be avoided in individuals with less than 25% G6PD activity when the FLR is less than 36%.
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Affiliation(s)
- P Krishna
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - A Rammohan
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India.
| | - R Rajalingam
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - G Narasimhan
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - R Cherukuru
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - D Sachan
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - A Rajakumar
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - I Kaliamoorthy
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - M S Reddy
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - M Rela
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
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Gómez Gómez S, Ruano Santiago M, Rodríguez Morillo A, Pérez Muñoz AM, Echevarría Moreno M. Anesthetic management of glucose 6-phosphate dehydrogenase deficiency. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:235-239. [PMID: 36842683 DOI: 10.1016/j.redare.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/19/2021] [Indexed: 02/28/2023]
Abstract
Glucose 6-phosphate dehydrogenase deficiency is the most common enzyme disease of red blood cells, with around 400 million people suffering from it throughout the world and linked to the X chromosome inheritance, thus it predominantly affects men. Glucose 6-phosphate-dehydrogenase participates in the pentose-phosphate pathway, being responsible for cellular metabolism and the production of antioxidants. A deficiency of this enzyme alters its ability to protect red blood cells from oxidative stress caused by certain drugs, metabolic conditions, infections and food. Specific anesthetic considerations are required to reduce the morbidity and mortality associated with medical-surgical interventions in patients with this disease. This article presents the case of a 45-year-old man with glucose 6-phosphate dehydrogenase deficiency who underwent combined general anaesthesia for programmed low anterior resection of the rectum.
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Affiliation(s)
- S Gómez Gómez
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario de Valme, Sevilla, Spain.
| | - M Ruano Santiago
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario de Valme, Sevilla, Spain
| | - A Rodríguez Morillo
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario de Valme, Sevilla, Spain
| | - A M Pérez Muñoz
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario de Valme, Sevilla, Spain
| | - M Echevarría Moreno
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario de Valme, Sevilla, Spain
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