Evaluation of the donor liver for living donor liver transplantation

Key Points. 1 Accurate assessment of the donor liver is an important component of the living donor liver evaluation and is critical to ensure a successful outcome for both donor and recipient. 2 Liver biochemistry tests, viral hepatitis serological tests, tests to exclude chronic liver disease, and volumetric computed tomographic or magnetic resonance (MR) imaging of the liver are performed routinely as part of the donor evaluation. 3 Liver biopsy should be a standard component of the donor evaluation in all donors, with the possible exception of those with a body mass index less than 25 who have normal liver test and abdominal imaging study results and no risk factors for chronic liver disease or hepatic steatosis. 4 The maximum acceptable percentage of steatosis in the donor liver is unknown, but most centers use an upper limit of 10% to 30%. 5 A graft-recipient body weight ratio of at least 0.8% provides the recipient with adequate hepatic mass in most situations. 6 Anatomic variants in donor biliary and hepatic vascular anatomy are common. 7 Evaluation of donor vascular anatomy varies among centers and includes MR or computed tomographic angiography and hepatic angiography. 8 Evaluation of biliary anatomy is performed most commonly using intraoperative cholangiography. Some centers use MR cholangiography or endoscopic retrograde cholangiopancreatography in selected situations.