Morphological Regeneration and Hepatic Functional Mass after Right Hemihepatectomy

Abstract

Background/Aims: Liver has a remarkable ability to regenerate after major resection. However, little is known about the process of morphological regeneration and hepatic functional recovery in human. Methods: Sixteen donors who underwent right hemihepatectomy were enrolled in this prospective clinical study. The preoperative liver volume and remnant liver volume on postoperative days 5, 12 and 28 were calculated from serial transverse computed tomography images. Liver function was evaluated by measuring the intrinsic clearance of antipyrine before and on postoperative days 5 and 12 days, as well as the biochemical and coagulation assay. Results: A smaller residual liver tended to regenerate faster in 28 days. Operative factors, including intraoperative blood loss, inflow occlusion time, liver transection time and duration of operation were not significantly correlated with postoperative liver regeneration. The intrinsic clearances of antipyrine on postoperative days 5 and 12 days were significantly reduced compared to the respective values before the operation (p < 0.001 and p < 0.05, respectively). On the contrary, the intrinsic clearance values per unit liver volume significantly increased on postoperative 12 days (p < 0.05). Conclusion: The microsomal function of individual hepatocytes may be upregulated after right liver resection perhaps in order to compensate for the reduced functional mass of the liver.

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

“…Similarly, patients with a higher estimated RLL more often recovered liver function at POD7, again suggesting the positive influence of a higher remnant, but more so emphasizing the importance of accurate estimation of the remnant preoperatively with state of the art imaging modalities and software (and by an experienced radiologist), and choosing donors with good RLL volumes. Contrary to findings in other studies (20,32,37) [14,18]), and also during the first month, (RLL/TLV ranged from 64% to 89% [25,30,33,49], and mean liver growth from 115% to 181% [14,25,27]). After the initial month, the rate of regeneration slowed down, RLL/TLV reaching 74-80% (33,38,40,53), 72-96% (17,23,29,31,37,46,(51)(52), and 80-97% (16,23,26,29,31,33,40,53) in the first 3 months, 6 months, and 1 year, respectively, after donor right hepatectomy.…”

“…In most other studies, incomplete liver regeneration was reported even up to 4 years after donation (33). Regarding factors influencing regeneration, some studies have suggested that age had an impact on regeneration (25,30,41), while several other studies showed that there was no impact of donor age on liver regeneration (16,27,33,38,45). We did find that increasing donor age had a negative influence on early as well as late volumetric recovery (on POD7 and POD365).…”

“…Our study is one of the first to objectively demonstrate this fact. Only three other studies used paired sample t-test (27,36,53) to analyze the ad integrum restoration of liver function tests. They also found that ad integrum recovery does not occur even up to 1-2 years after donor hepatectomy.…”

99mTc-GSA Scintigraphy with SPECT for Assessment of Hepatic Function and Functional Volume During Liver Regeneration in a Rat Model of Partial Hepatectomy

“…Others, however, concluded that the functional regeneration was more rapid than the morphologic regeneration (6,7). These results support the theory that hepatocyte function is upregulated after major hepatic resection to compensate for the reduced liver mass (22,31,32). Therefore, it remains difficult to draw conclusions with regard to the difference between functional and volumetric regeneration.…”

Quantitative Assessment of Hepatic Function During Liver Regeneration in a Standardized Rat Model

“…This is supported by Tanaka et al (35), who found that functional regeneration measured by 99m Tc-GSA scintigraphy was impaired, compared with the volumetric regeneration in patients who had undergone extensive liver resection. The second theory postulates that hepatocellular function is enhanced after major PHx to compensate for reduced liver mass (36)(37)(38). In our study, functional recovery, compared with the volumetric recovery, was impaired on the first day after 70% PHx, as evidenced by the relatively lower liver function measured by all quantitative liver function tests except GEC.…”