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Yoon, Park, Hong, You, and Kim: Liver Regeneration and Factors Influencing Liver Regeneration in Donors and Recipients of Adult Living Donor Liver Transplantation Using Right Lobe Graft
Original Article

J Korean Soc Transplant 2011;25(2):87-94.

Published online: 10 June 2011

DOI: https://doi.org/10.4285/jkstn.2011.25.2.87

Liver Regeneration and Factors Influencing Liver Regeneration in Donors and Recipients of Adult Living Donor Liver Transplantation Using Right Lobe Graft

Young Chul Yoon, M.D., Jung Hyun Park, M.D., Tae Ho Hong, M.D., Young Kyoung You, M.D., Dong Goo Kim, M.D.

Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea

책임저자：김동구, 서울시 서초구 반포동 505가톨릭대학교 서울성모병원 외과, 137-701 Tel: 02-2258-6096, Fax: 02-595-2822 E-mail: kimdg@catholic.ac.kr

Copyright © 2011 The Korean Society for Transplantation

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

To balance between the appropriate remnant liver volume in the donors and sufficient graft volume in the recipients is very important in adult living donor liver transplantation (LDLT). The aim of this study is to evaluate the liver regeneration rate and the factors associated with the regenerative process in the donors and recipients.

Methods

Between May 1999 and March 2010, 197 donors and 98 recipients out of the 450 patients who underwent adult LDLT were evaluated retrospectively. We reviewed the clinical characteristics of the patients, liver regeneration using computerized tomography (CT)-assisted volumetry technique and the factors associated with liver regeneration in the donors and recipients.

Results

Using CT-assisted volumetry, the mean proportion of remnant right liver lobe was 62.4%±4.7%, ranging from 50.1% to 77.4%. The ratio of the graft weight to volume by CT-assisted volumetry was 89.8%±12.9% and we created a formula that graft volume (g)= [CT volume (mL)×0.933]+137.97. The liver regeneration rate in donors during the first postoperative week was higher if the remnant liver volume was below 35% than if the remnant liver volume above 35% (P＜0.001). After 6 months, the remnant liver grew up to 81.2% of the original liver volume. Liver regeneration in recipients during the first postoperative week was faster if the graft-to-recipient body weight ratio (GRWR) was below 1% than if the GRWR was above 1% (P＜0.001). Also, GRWR (P＜0.001), portal vein (PV) velocity (cm/sec) (P=0.007) and PV flow volume per 100 g of graft tissue (mL/min) (P=0.002) were associated with liver regeneration in recipients during the early postoperative period by univariate analysis.

Conclusions

The process of liver regeneration was most active during the first postoperative week in both the donors and recipients. The proportion of remnant liver in donors, GRWR and portal blood flow in recipients appeared to be the significant factors associated with liver regeneration.

Keywords: Liver transplantation, Living donors, Liver regeneration

References

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Fig. 1.
Positive correlation between the estimated graft volume (ml) and actural graft weight (g).
jkstn-25-87f1.tif
Table 1.
Partial liver regeneration of donor and recipient after living donor LT (A)
At the time of LT 1 week later 3 months later 6 months later
37.6±4.9% 58.9±7.9% 74.1±10.2% 81.2±11.5%
100% 158.5±29.4% a 200.1±42.1% b 244.3±48.4%
(B)      
At the time of LT 1 week later 20 days later 3 months later
100% 159.2±32.0% a 178.4±50.3% 219.5±56.6% b

Abbreviation: LT, liver transplantation. (A) Volume of left lobe by CT volumetry in donor (n=197), (B) Volume of graft liver by CT volumetry in recipient (n=98)a P =0.851; b =0.239.

a P =0.851;

b P =0.239.;

Table 2.
Peak liver enzymes difference according to risk factors after right lobectomy in donor
    Peak bilirubin (mg/dL) P Peak ALT (U/L) P
Age ≤55 2.92±1.31 0.019 253.37±181.95 0.682
  ＞55 5.14±2.37   200.50±30.41  
Fatty ≤10% 2.89±1.33 0.166 248.07±181.42 0.165
change ＞10% 3.34±1.49   308.50±200.75  
Remained ≤35% 3.32±1.70 0.036 317.73±247.69 0.013
volume ＞35% 2.79±1.13   227.70±140.78  
Table 3.
Remnant liver regeneration difference according to risk factors after right hepatectomy in donor
    7 days P 3 months P 6 months P
Age ≤55 58.4±29.0% 0.785 27.6±16.8% 0.751 10.2±13.0% 0.913
  ＞55 76.8±74.1%   31.4±11.2%   9.6±7.8%  
Fatty change ≤10% 57.6±28.8% 0.970 27.4±17.2% 0.223 10.0±12.8% 0.578
  ＞10% 57.3±28.9%   32.2±12.9%   11.7±14.2%  
Remained volume ≤35% 79.9±34.6% ＜0.001 33.4±18.4% 0.002 8.5±11.8% 0.279
  ＞35% 50.3±22.3%   25.5±15.5%   10.8±13.4%  
Table 4.
Correlation between graft regeneration and clinical variables (A) Graft regeneration on postoperative 7th day
Variables Coefficients P
Donor age Recipient age 0.074−0.065 0.470 0.527
Fatty change (%) −0.108 0.290
GRWR (%) −0.371 ＜0.001
Spleen index (cm3) a 0.055 0.587
Hematocrit (%) 0.027 0.793
Glucose (mg/dL) 0.019 0.857
Platelet (/L) 0.085 0.409
PT (INR) 0.102 0.324
BMI (kg/m2) 0.130 0.205
PV velocity (cm/sec) 0.271 0.007
PV volume (mL/min) 0.130 0.202
PV volume/Graft 100 g (mL/min) 0.313 0.002
(B) Graft regeneration on postoperative 20th day
Variables Coefficients P
Donor age −0.066 0.521
Recipient age −0.007 0.947
Fatty change (%) −0.183 0.073
GRWR (%) −0.223 0.027
Spleen index (cm3) a 0.015 0.882
Hematocrit (%) −0.134 0.192
Glucose (mg/dL) 0.046 0.657
Platelet (/L) −0.134 0.193
PT (INR) 0.100 0.337
BMI (kg/m2) 0.071 0.490
PV velocity (cm/sec) 0.027 0.795
PV volume (mL/min) 0.033 0.747
PV volume/Graft 100 g (mL/min) 0.103 0.315

Abbreviations: GRWR, graft to recipient-body weight ratio; PT, prothrombin time; BMI, body mass index; PV, portal vein.

a spleen index=height×length×width of spleen.

Table 5.
Graft regeneration difference according to various risk factors after living donor liver transplantation
    7 days P 20 days P
Donor age ≤55 58.9±32.3% 0.492 11.2±17.1% 0.689
  ＞55 74.7±4.2%   16.2±28.1%  
Recipient ≤50 61.7±34.5% 0.447 11.8±16.9% 0.792
age ＞50 56.8±29.5%   10.9±17.5%  
Fatty ≤10% 60.5±31.6% 0.074 11.7±17.2% 0.604
change ＞10% 38.1±31.3%   8.1±18.3%  
GRWR ＜1% 82.6±39.7% ＜0.001 15.9±20.9% 0.233
  ≥1% 54.4±28.1%   10.4±16.2%  
MHV Patent 60.5±32.4% 0.196 11.0±17.3% 0.540
patency Occluded 45.2±25.2%   14.9±16.1%  
Immune FK 56.8±30.9% 0.326 11.0±16.2% 0.807
suppression CsA 63.3±33.9%   11.9±18.8%  

Abbreviations: GRWR, graft to recipient-body weight ratio; MHV, middle hepatic vein.

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