Ad Integrum Functional and Volumetric Recovery in Right Lobe Living Donors: Is It Really Complete 1 Year After Donor Hepatectomy?

Abstract

Julie Duclos and Prashant Bhangui are co-first authors.The partial liver's ability to regenerate both as a graft and remnant justifies right lobe (RL) living donor liver transplantation. We studied (using biochemical and radiological parameters) the rate, extent of, and predictors of functional and volumetric recovery of the remnant left liver (RLL) during the first year in 91 consecutive RL donors. Recovery of normal liver function (prothrombin time [PT] !70% of normal and total bilirubin [TB] 20 mmol/L), liver volumetric recovery, and percentage RLL growth were analyzed. Normal liver function was regained by postoperative day's 7, 30, and 365 in 52%, 86%, and 96% donors, respectively. Similarly, mean liver volumetric recovery was 64%, 71%, and 85%; whereas the percentage liver growth was 85%, 105%, and 146%, respectively. Preoperative PT value (p ¼ 0.01), RLL/total liver volume (TLV) ratio (p ¼ 0.03), middle hepatic vein harvesting (p ¼ 0.02), and postoperative peak TB (p < 0.01) were predictors of early functional recovery, whereas donor age (p ¼ 0.03), RLL/ TLV ratio (p ¼ 0.004), and TLV/ body weight ratio (p ¼ 0.02) predicted early volumetric recuperation. One-year post-RL donor hepatectomy, though functional recovery occurs in almost all (96%), donors had incomplete restoration (85%) of preoperative total liver volume. Modifiable predictors of regeneration could help in better and safer donor selection, while continuing to ensure successful recipient outcomes.Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; BSA, body surface area; CT, computed tomography scan; GGT, gamma glutamyl transpeptidase; ICG RT15 , indocyanine green retention rate at 15 min; ISGLS, International Study Group of Liver Surgery; MHV, middle hepatic vein; PHLF, posthepatectomy liver failure; POD, postoperative day; PT, prothrombin time; RL, right lobe; RLL, remnant left liver; RLLDLT, right lobe living donor liver transplantation; RLL/BW, remnant left liver to body weight ratio; RLL/TLV, remnant left liver to total liver volume ratio; SLV, standard liver volume; TB, serum total bilirubin; TLV, total liver volume

Impact of donor age on liver regeneration and function following adult living donor liver transplantation

“…The volume of the residual liver was ~50% of ESLV, and all donors recovered well following surgery, which indicated that the decrease in liver regeneration is a subclinical process; additionally, the residual liver function was able to meet the metabolic requirements. According to the literature, the recovery of donor liver volume was still incomplete at 1 year post-donation, accounting for 85% of the total preoperative volume; however, liver function had almost returned to normal (16).…”

In search of a pathogenesis for impaired liver regeneration after major hepatectomy with extrahepatic bile duct resection: The plot thickens!

“…Furthermore, both serum total bilirubin and prothrombin time/INR are surely indices of liver function, but they are also influenced by several clinical factors that may alter the direct correlation between volumetric regeneration and function recovery. Finally, vLR after major hepatectomy shows complex kinetics that is mainly characterized by a sharp and steady volume increase in the first postoperative week up to the first postoperative month, followed by a slower regenerative rate during the subsequent 3 months, and a late long‐term stabilization up to 1 year after surgery . Therefore, a seriated volumetric assessment at different postoperative time points, rather than a single measurement normalized by a time interval, might be a more appropriate and reliable approach for vLR analysis.…”

Factors Affecting Liver Regeneration in Donors&apos; Grafts in Living Donor Liver Transplant (LDLT) a Center Experience

“…According to the literature, the recovery of donor liver volume was still incomplete at 1 year post donation, accounting for 85% of the total preoperative volume; however, liver function had almost returned to normal [19].…”