Abstract：
The essential premise of living donor liver transplantation is the assurance that the donors will have a complication-free perioperative course and a prompt recovery. Selection of appropriate donors is the first step to support this premise and is based on tests that constitute the donor workup. The exclusion of liver pathologies and assessment of liver anatomy and volume in the donor candidate are the most important elements in the selection of the appropriate candidate.
To determine whether there is evidence to define an optimal donor surgical workup that would improve short-term outcomes of the donor after living liver donation.
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.
Although a liver biopsy remains the only method to exactly determine the percentage and type of steatosis and to detect other liver pathologies, its routine use is not supported. Both magnetic resonance imaging (MRI) and computed tomography (CT) appear to be adequate for quantifying liver volume; the preference for one or the other is often based on center expertise. MRI is clearly a better technique to assess biliary anatomy, although aberrant biliary anatomy may not be clearly detected. MRI is also more accurate than CT in determining low grades of steatosis. CT angiography is the imaging test of choice to assess the vascular anatomy. There is no evidence of the need for catheter angiography in the modern evaluation of a living liver donor.
A donor liver biopsy is indicated if abnormalities are present in serological or imaging tests. Both MRI and CT imaging appear to be adequate methodologies. The routine use of catheter angiography is not supported in view of the adequacy of CT angiography in delineating liver vascular anatomy. No imaging modality available to quantify liver volume is superior to another. Biliary anatomy is better defined with MRI, although poor definition can be expected, particularly for abnormal ducts.
To determine whether there is evidence to define an optimal donor surgical workup that would improve short-term outcomes of the donor after living liver donation.
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.
Although a liver biopsy remains the only method to exactly determine the percentage and type of steatosis and to detect other liver pathologies, its routine use is not supported. Both magnetic resonance imaging (MRI) and computed tomography (CT) appear to be adequate for quantifying liver volume; the preference for one or the other is often based on center expertise. MRI is clearly a better technique to assess biliary anatomy, although aberrant biliary anatomy may not be clearly detected. MRI is also more accurate than CT in determining low grades of steatosis. CT angiography is the imaging test of choice to assess the vascular anatomy. There is no evidence of the need for catheter angiography in the modern evaluation of a living liver donor.
A donor liver biopsy is indicated if abnormalities are present in serological or imaging tests. Both MRI and CT imaging appear to be adequate methodologies. The routine use of catheter angiography is not supported in view of the adequacy of CT angiography in delineating liver vascular anatomy. No imaging modality available to quantify liver volume is superior to another. Biliary anatomy is better defined with MRI, although poor definition can be expected, particularly for abnormal ducts.
摘要：
背景：活体肝移植的基本前提是确保供体将获得无并发症的围手术期和迅速恢复。选择合适的供体是支持这一前提的第一步，并且基于构成供体工作的测试。排除肝脏病理学和评估供体候选者中的肝脏解剖结构和体积是选择合适候选者的最重要因素。
目的：确定是否有证据确定最佳的供体手术检查，以改善活体肝脏捐献后供体的短期预后。
方法：OvidMedline，Embase,Scopus,谷歌学者，和CochraneCentral.
方法：遵循PRISMA指南和建议，使用来自国际专家小组的GRADE方法进行系统审查。
结果：尽管肝活检仍然是准确确定脂肪变性百分比和类型以及检测其他肝脏病变的唯一方法，不支持其常规使用。磁共振成像（MRI）和计算机断层扫描（CT）似乎都足以量化肝脏体积；对一个或另一个的偏好通常基于中心的专业知识。MRI显然是评估胆道解剖的更好技术，尽管胆道解剖异常可能无法明确检测到。在确定低度脂肪变性方面，MRI也比CT更准确。CT血管造影是评估血管解剖结构的首选影像学检查。在对活体肝脏供体的现代评估中，没有证据表明需要导管血管造影。
结论：如果在血清学或影像学检查中存在异常，则应进行供体肝活检。MRI和CT成像似乎都是适当的方法。鉴于CT血管造影在描绘肝脏血管解剖结构方面的充分性，不支持常规使用导管血管造影。没有可用于量化肝脏体积的成像模式优于另一种。MRI能更好地定义胆道解剖结构,虽然可以预期较差的定义，特别是异常管道。
目的：确定是否有证据确定最佳的供体手术检查，以改善活体肝脏捐献后供体的短期预后。
方法：OvidMedline，Embase,Scopus,谷歌学者，和CochraneCentral.
方法：遵循PRISMA指南和建议，使用来自国际专家小组的GRADE方法进行系统审查。
结果：尽管肝活检仍然是准确确定脂肪变性百分比和类型以及检测其他肝脏病变的唯一方法，不支持其常规使用。磁共振成像（MRI）和计算机断层扫描（CT）似乎都足以量化肝脏体积；对一个或另一个的偏好通常基于中心的专业知识。MRI显然是评估胆道解剖的更好技术，尽管胆道解剖异常可能无法明确检测到。在确定低度脂肪变性方面，MRI也比CT更准确。CT血管造影是评估血管解剖结构的首选影像学检查。在对活体肝脏供体的现代评估中，没有证据表明需要导管血管造影。
结论：如果在血清学或影像学检查中存在异常，则应进行供体肝活检。MRI和CT成像似乎都是适当的方法。鉴于CT血管造影在描绘肝脏血管解剖结构方面的充分性，不支持常规使用导管血管造影。没有可用于量化肝脏体积的成像模式优于另一种。MRI能更好地定义胆道解剖结构,虽然可以预期较差的定义，特别是异常管道。
