Volumetric and functional recovery of the liver after right hepatectomy for living donation

Abstract

Our objective was to study the kinetics of recovery of the liver volume and liver function after right hepatectomy (RH) for living donation, comparing conventional and quantitative liver function tests, i.e., galactose elimination capacity (GEC). A total of 27 donors underwent RH averaging 61% of the whole liver volume. The conventional and quantitative liver function tests, as well as magnetic resonance imaging volumetric studies, were performed preoperatively at postoperative day (POD) 10, 90, 180, and 360. Mean residual volume increased by 88% within 10 days from RH and thereafter did not show any significant variation. After 1 year, only 83% of the original volume was reached. GEC per milliliter of liver volume expressed in percent of initial value (GEC/mL) showed a decrease of 25% at POD10, an increase up to 125% at POD 180, and returned to normal values at POD 360. Liver biochemistries, International Normalized Ratio (INR), and bilirubin returned to normal in 10 days. Cholinesterase showed a similar course like GEC. In conclusion, within 10 days of 61% loss of its initial volume, the liver is capable of regenerating a volume necessary to its function, although it corresponds to only 74% of the initial one. It takes only 10 days to normalize liver biochemistries, while cholinesterase and albumin recover over 90 days. However, a direct measure of the cytosolic liver function obtained by GEC shows that functional recovery occurs much more gradually than the recovery of volume and liver biochemistries. (Liver

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

“…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 our study, liver volume increased to more than 2Â estimated remnant liver volume at the end of 1 year, yet ad integrum liver regeneration did not occur.…”

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

“…Over the last decades, several quantitative dynamic liver function tests have been developed, each measuring a distinct component of liver function. These quantitative dynamic liver function tests include the indocyanine green (ICG) clearance test and the galactose elimination capacity (GEC) (6)(7)(8), of which the former is the most frequently used (2). ICG is a tricarbocyanine dye almost exclusively cleared from the plasma by hepatocyte transporters located on the basolateral membrane and subsequently excreted into the bile without biotransformation (9).…”

Hypoxia of the growing liver accelerates regeneration

“…3 In contrast, >50% hepatectomy is associated with a rapid and extensive regeneration with the degree of hypertrophy at 80-90% within 10 days. 4 It is interesting to note that, in contrast to partial hepatectomy, no tissue is removed during portal vein occlusion. The observation that the liver regenerates after redirection of portal flow alone has led to the hypothesis that changes in portal vein hemodynamics may be contributing signals for liver regeneration.…”