Journal of Gastrointestinal Surgery

, Volume 15, Issue 9, pp 1594–1601 | Cite as

Convergence Process of Volumetric Liver Regeneration After Living-Donor Hepatectomy

  • Taku Aoki
  • Hiroshi ImamuraEmail author
  • Yutaka Matsuyama
  • Yoji Kishi
  • Takashi Kobayashi
  • Yasuhiko Sugawara
  • Masatoshi Makuuchi
  • Norihiro Kokudo
Original Article



We investigated the long-term profiles of liver regeneration after living-donor hepatectomy.


Thirty-three donors participated in the study. Preoperative and postoperative liver volume was calculated using computed tomography. Volume assessment was repeated at 1 week, 2 weeks, 1 month, 3 months, 6 months, 12 months, and 4 years postoperatively.


Donors were divided into the right (n = 23; residual liver volume, 42%) and left (n = 10; residual liver volume, 63%) groups according to the operative procedures. The restoration ratio to the preoperative liver volume (right vs. left groups) were 51%, 57%, 64%, 74%, 77%, 81%, and 88% vs. 69%, 72%, 76%, 79%, 83%, 84%, and 91% at 1 week, 2 weeks, 1 month, 3 months, 6 months, 12 months, and 4 years, respectively; the interindividual variation in the restoration ratio to the preoperative liver volume became narrower with time.


Liver resection in humans resulted in rapid regeneration during the first 3 months, followed by a more moderate rate of regeneration thereafter, in proportion to the amount of liver mass resected. The volume of the regenerating liver appeared to converge towards the individual preoperative volume with time. However, the liver volume was not restored to the preoperative volume at 4 years after the resection.


CT volumetry Donor hepatectomy Liver regeneration Total liver volume 





Living-donor liver transplantation


Total liver volume


Computed tomography


Indocyanine green


Body mass index


Total bilirubin


Aspartate aminotransferase


Alanine aminotransferase


Prothrombin time international normalized ratio


ICG retention rate at 15 min



This study was supported in part by a Grant-in-Aid for Scientific Research (B) (20390352).

Financial Disclosure

None reported.


  1. 1.
    Higgins GM, Anderson RM. Experimental pathology of the liver. I. Restoration of the liver of the white rat following partial surgical removal. Arch Pathol 1931; 12: 186–202.Google Scholar
  2. 2.
    Bucher NLR, Swaffield MN. The rate of incorporation of labeled thymidine into the deoxyribonucleic acid of regenerating rat liver in relation to the amount of liver excised. Cancer Res 1964; 24: 1611–1625.PubMedGoogle Scholar
  3. 3.
    Michalopoulos GK, DeFrances MC. Liver regeneration. Science 1997; 276: 60–66.PubMedCrossRefGoogle Scholar
  4. 4.
    Kam I, Lynch S, Svanas G, Todo S, Polimeno L, Francavilla A, Penkrot RJ, Takaya S, Ericzon BG, Starzl TE, van Thiel DH. Evidence that host size determines liver size: studies in dogs receiving orthotopic liver transplants. Hepatology 1987; 7: 362–366.PubMedCrossRefGoogle Scholar
  5. 5.
    Hashikura Y, Makuuchi M, Kawasaki S, Matsunami H, Ikegami T, Nakazawa Y, Kiyosawa K, Ichida T. Successful living-related partial liver transplantation to an adult patient. Lancet 1994; 343: 1233–1234.PubMedCrossRefGoogle Scholar
  6. 6.
    Fan ST. Live donor liver transplantation in adults. Transplantation 2006; 82: 723–732.PubMedCrossRefGoogle Scholar
  7. 7.
    Lin TY, Lee CS, Chen CC, Liau KY, Lin WS. Regeneration of human liver after hepatic lobectomy studied by repeated liver scanning and repeated needle biopsy. Ann Surg 1979; 190: 48–53.PubMedCrossRefGoogle Scholar
  8. 8.
    Nagasue N, Yukaya H, Ogawa Y, Kohno H, Nakamura T. Human liver regeneration after major hepatic resection: a study of normal liver and livers with chronic hepatitis and cirrhosis. Ann Surg 1987: 206: 30–39.PubMedCrossRefGoogle Scholar
  9. 9.
    Yamanaka N, Okamoto E, Kawamura E, Kato T, Oriyama T, Fujimoto J, Furukawa K, Tanaka T, Tomoda F, Tanaka W. Dynamics of normal and injured human liver regeneration after hepatectomy as assessed on the basis of computed tomography and liver function. Hepatology 1993; 18: 79–85.PubMedCrossRefGoogle Scholar
  10. 10.
    Kawasaki S, Makuuchi M, Ishizoe S, Matsunami H, Terada M, Kawarazaki H. Liver regeneration in recipients and donors after transplantation. Lancet 1992; 339: 580–581.PubMedCrossRefGoogle Scholar
  11. 11.
    Marcos A, Fisher RA, Ham JM, Shiffman ML, Sanyal AJ, Luketic VA, Sterling RK, Fulcher AS, Posner MP. Liver regeneration and function in donor and recipient after right lobe adult to adult living donor liver transplantation. Transplantation 2000; 69: 1375–1379.PubMedCrossRefGoogle Scholar
  12. 12.
    Kamel IR, Erbay N, Warmbrand G, Kruskal JB, Pomfret EA, Raptopoulos V. Liver regeneration after living adult right lobe transplantation. Abdom Imaging 2003; 28: 53–57.PubMedCrossRefGoogle Scholar
  13. 13.
    Pomfret EA, Pomposelli JJ, Gordon FD, Erbay N, Lyn Price L, Lewis WD, Jenkins RL. Liver regeneration and surgical outcome in donors of right-lobe liver grafts. Transplantation 2003; 76: 5–10.PubMedCrossRefGoogle Scholar
  14. 14.
    Humar A, Kosari K, Sielaff TD, Glessing B, Gomes M, Dietz C, Rosen G, Lake J, Payne WD. Liver regeneration after adult living donor and deceased donor split-liver transplants. Liver Transpl 2004; 10: 374–378.PubMedCrossRefGoogle Scholar
  15. 15.
    Nadalin S, Testa G, Malagó M, Beste M, Frilling A, Schroeder T, Jochum C, Gerken G, Broelsch CE. Volumetric and functional recovery of the liver after right hepatectomy for living donation. Liver Transpl 2004; 10: 1024–1029.PubMedCrossRefGoogle Scholar
  16. 16.
    Ibrahim S, Chen CL, Wang CC, Wang SH, Lin CC, Liu YW, Yang CH, Yong CC, Concejero A, Cheng YF. Liver regeneration and splenic enlargement in donors after living-donor liver transplantation. World J Surg 2005; 29: 1658–1666.PubMedCrossRefGoogle Scholar
  17. 17.
    Yokoi H, Isaji S, Yamagiwa K, Tabata M, Sakurai H, Usui M, Mizuno S, Uemoto S. Donor outcome and liver regeneration after right-lobe graft donation. Transpl Int 2005; 18: 915–922.PubMedCrossRefGoogle Scholar
  18. 18.
    Chan SC, Lo CM, Wong Y, Liu CL, Fan ST. Long-term biological consequences of donor right hepatectomy including the middle hepatic vein in adult-to-adult live donor liver transplantation. Liver Transpl 2006; 12: 259–263.PubMedCrossRefGoogle Scholar
  19. 19.
    Yamashiki N, Sugawara Y, Tamura S, Kaneko J, Nojiri K, Omata M, Makuuchi M. Selection of liver-transplant candidates for adult-to-adult living donor liver transplantation as the only surgical option for end-stage liver disease. Liver Transpl 2006; 12: 1077–1083.PubMedCrossRefGoogle Scholar
  20. 20.
    Tamura S, Sugawara Y, Kaneko J, Yamashiki N, Kishi Y, Matsui Y, Kokudo N, Makuuchi M. Systematic grading of surgical complications in live liver donors according to Clavien’s system. Transpl Int 2006; 19: 982–987.PubMedCrossRefGoogle Scholar
  21. 21.
    Heymsfield SB, Fulenwider T, Nordlinger B, Barlow R, Sones P, Kutner M. Accurate measurement of liver, kidney, and spleen volume and mass by computed axial tomography. Ann Intern Med 1979; 90:185–187.PubMedGoogle Scholar
  22. 22.
    Kokudo N, Sugawara Y, Imamura H, Sano K, Makuuchi M. Tailoring the type of donor hepatectomy for adult living donor liver transplantation. Am J Transplant 2005; 5: 1694–1703.PubMedCrossRefGoogle Scholar
  23. 23.
    Kobayashi T, Imamura H, Aoki T, Sugawara Y, Kokudo N, Makuuchi M. Morphological regeneration and hepatic functional mass after right hemihepatectomy. Dig Surg 2006; 23: 44–50.PubMedCrossRefGoogle Scholar
  24. 24.
    Makuuchi M, Kawasaki S, Noguchi T, Hashikura Y, Matsunami H, Hayashi K, Harada H, Kakazu T, Takayama T, Kawarasaki H. Donor hepatectomy for living related partial liver transplantation. Surgery 1993;113: 395–402.PubMedGoogle Scholar
  25. 25.
    Takayama T, Makuuchi M, Kubota K, Sano K, Harihara Y, Kawarasaki H. Living related transplantation of left liver plus caudate lobe. J Am Coll Surg 2000; 190: 635.PubMedCrossRefGoogle Scholar
  26. 26.
    Sugawara Y, Makuuchi M, Takayama T, Imamura H, Kaneko J. Right lateral sector graft in adult living-related liver transplantation. Transplantation 2002; 73:111.PubMedCrossRefGoogle Scholar
  27. 27.
    Kokudo N, Sugawara Y, Imamura H, Sano K, Makuuchi M. Sling suspension of the liver in donor operation: a gradual tape-repositioning technique. Transplantation 2003; 76: 803–807.PubMedCrossRefGoogle Scholar
  28. 28.
    Maema A, Imamura H, Takayama T, Sano K, Hui AM, Sugawara Y, Makuuchi M. Impaired volume regeneration of split livers with partial venous disruption: a latent problem in partial liver transplantation. Transplantation 2002; 73: 765–769.PubMedCrossRefGoogle Scholar
  29. 29.
    Hata S, Sugawara Y, Kishi Y, Niiya T, Kaneko J, Sano K, Imamura H, Kokudo N, Makuuchi M. Volume regeneration after right liver donation. Liver Transpl 2004; 10: 65–70.PubMedCrossRefGoogle Scholar
  30. 30.
    Imamura H, Takayama T, Sugawara Y, Kokudo N, Aoki T, Kaneko J, Matsuyama Y, Sano K, Maema A, Makuuchi M. Pringle’s manoeuvre in living donors. Lancet 2002; 360: 2049–2050.PubMedCrossRefGoogle Scholar
  31. 31.
    Altman DG. Comparing means among two (or more) independent populations. In: Altman DG, ed. Practical statistics for medical research. London, England: Chapman & Hall, 1991; 440–477.Google Scholar
  32. 32.
    Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol 1993; 138: 923–936.PubMedGoogle Scholar
  33. 33.
    Kawasaki S, Makuuchi M, Matsunami H, Hashikura Y, Ikegami T, Chisuwa H, Ikeno T, Noike T, Takayama T, Khono S. Preoperative measurement of segmental liver volume of donors for living related liver transplantation. Hepatology 1993; 18: 1115–1120.PubMedCrossRefGoogle Scholar
  34. 34.
    Abdalla EK, Denys A, Chevalier P, Nemr RA, Vauthey JN. Total and segmental liver volume variations: implications for liver surgery. Surgery 2004; 135: 404–410.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Taku Aoki
    • 1
  • Hiroshi Imamura
    • 1
    • 3
    Email author
  • Yutaka Matsuyama
    • 2
  • Yoji Kishi
    • 1
  • Takashi Kobayashi
    • 1
  • Yasuhiko Sugawara
    • 1
  • Masatoshi Makuuchi
    • 1
  • Norihiro Kokudo
    • 1
  1. 1.Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Graduate School of MedicineUniversity of TokyoTokyoJapan
  2. 2.Department of Biostatistics, Graduate School of MedicineUniversity of TokyoTokyoJapan
  3. 3.Department of Hepatobiliary-Pancreatic SurgeryJuntendo School of MedicineTokyoJapan

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