Adams Megan A, Andacoglu Oya, Crouch Cara E, de Santibañes Martin, Jackson Whitney E, Jalal Arif, Montasser Iman F, Rubman Susan, Spiro Michael, Raptis Dimitri Aristotle, Miller Charles, Pomfret Elizabeth
Division of Transplantation, Department of Surgery, and Colorado Center for Transplantation Care, University of Colorado School of Medicine, Research and Education (CCTCARE), Aurora, Colorado, USA.
Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, CO, USA.
Clin Transplant. 2022 Oct;36(10):e14636. doi: 10.1111/ctr.14636.
There is some evidence in the literature to suggest that pre-operative counselling improves pain scores postoperatively. However, it is unclear whether pre-operative counselling of the donor improves immediate and short-term outcomes after living liver donation.
This systematic review aimed to investigate the available quality of evidence (QOE) of pre-operative counselling for living donors on short term outcomes, provide expert opinion, grade recommendations and identify relevant components for Enhanced Recovery after Surgery (ERAS) protocols.
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. Endpoints were defined by the WHOQOL-BREF scale: physical health, psychological, social relationships, and environment.
CRD42021260677.
Screening of 452 records and full texts led to 12 articles matching inclusion criteria, of which one was a randomized controlled trial (RCT), and 11 were observational retrospective cohort studies. A total of 933 individuals undergoing donor hepatectomy were included, of whom only 90 received dedicated perioperative ERAS protocols. Donors that received pre-operative counselling had fewer physical symptoms post donation, lower rates of fatigue, lower rates of pain, shorter recovery times and fewer unexpected medical problems, and less anxiety post donation. Female donors had higher affective and adverse effects scores, and 50% of donors reported adverse effects to analgesia that interfered with functional activity. Receiving information about analgesic options increased perception of care among donors.
Providing comprehensive pre-operative counselling to living liver donors is associated with improved short-term outcomes after donation (QOE; moderate to low I Grade of Recommendation; Strong).
文献中有一些证据表明术前咨询可改善术后疼痛评分。然而，供体的术前咨询是否能改善活体肝移植后的近期和短期结局尚不清楚。
本系统评价旨在调查活体供体术前咨询对短期结局的现有证据质量（QOE），提供专家意见，分级推荐并确定术后加速康复（ERAS）方案的相关组成部分。
Ovid MEDLINE、Embase、Scopus、谷歌学术和Cochrane中心。
按照PRISMA指南进行系统评价，并采用来自国际专家小组的GRADE方法进行推荐。终点由世界卫生组织生活质量简表（WHOQOL-BREF）量表定义：身体健康、心理、社会关系和环境。
PROSPERO注册号：CRD42021260677。
对452条记录和全文进行筛选后，有12篇文章符合纳入标准，其中1篇为随机对照试验（RCT），11篇为观察性回顾性队列研究。共纳入933例接受供体肝切除术的个体，其中只有90例接受了专门的围手术期ERAS方案。接受术前咨询的供体术后身体症状较少、疲劳率较低、疼痛率较低、恢复时间较短、意外医疗问题较少，且术后焦虑较少。女性供体的情感和不良反应评分较高，50%的供体报告镇痛不良反应影响功能活动。了解镇痛选择信息可提高供体对护理的感知。
为活体肝供体提供全面的术前咨询与捐赠后改善短期结局相关（QOE；推荐等级为中等至低；强烈）。
