Skip to main content

Kinetics of liver regeneration in donors after living donor liver transplantation: A retrospective analysis of “2/3rd partial hepatectomy” model at 3 months

Abstract

Background/Aim

Right lobe living donor (2/3rd partial hepatectomy) model is the best way to accurately study liver regeneration process in human beings. We aimed to study the kinetics of liver regeneration after 2/3rd partial hepatectomy in donors.

Methods

Retrospective analysis of prospectively maintained volumetric recovery data in donors was performed in 23 donors, who underwent 29 contrast-enhanced computed tomography within 3 months for various clinical indications.

Results

The absolute volumetric growth percentages were as follows: 37.60 ± 21.74 at 1st week, 92 ± 53.27 at 2nd week, 115.55 ± 59.65 at 4th week, and 110.79 ± 64.47 at 3 months. On sub-group analysis of our cohort, we found that 4.3%, 17%, 30.4%, and 39% donors attended ≥ 90% volumetric recovery at 1st, 2nd, 4th week, and 3 months, respectively. One patient at 4th week revealed 128% volumetric recovery. There was one more patient who exceeded original total liver volumes (TLV) (111% of TLV) at 2.5 months. The serum bilirubin and INR values peaked at postoperative day (POD) 3rd and then started showing a downward trend from POD 5th onwards.

Conclusion

Our study is the first to document complete volumetric recovery in donors as early as 3 weeks. Two of the donors overshot their original TLV during the early regenerative phase.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Marcos A, Fisher RA, Ham JM, et al. Liver regeneration and function in donor and recipient after right lobe adult to adult living donor liver transplantation. Transplantation. 2000;69:1375–9.

  2. Humar A, Kosari K, Sielaff TD, et al. Liver regeneration after adult living donor and deceased donor split-liver transplants. Liver Transpl. 2004;10:374–8.

  3. Olthoff KM, Emond JC, Shearon TH, et al. Liver regeneration after living donor transplantation: adult-to-adult living donor liver transplantation cohort study. Liver Transpl. 2015;21:79–88.

  4. Soin AS, Mohanka R, Singla P, et al. Segment IV preserving middle hepatic vein retrieval in right lobe living donor liver transplantation. J Am Coll Surg. 2011;213:e5–16.

  5. Scatton O, Belghiti J, Dondero F, et al. Harvesting the middle hepatic vein with a right hepatectomy does not increase the risk for the donor. Liver Transpl. 2004;10:71–6.

  6. Michalopoulos GK. Liver regeneration. J Cell Physiol. 2007;213:286–300.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Gruttadauria S, Parikh V, Pagano D, et al. Early liver regeneration of remnant liver volume after right hepatectomy for living donation: a multiple regression analysis. Liver Transpl. 2012;18:907–13.

  8. Pomfret EA, Pomposelli JJ, Lewis WD, et al. Live donor adult liver transplantation using right lobe grafts: donor evaluation and surgical outcome. Arch Surg. 2001;136:425–33.

  9. Pomfret EA, Pomposelli JJ, Gordon FD, et al. Liver regeneration and surgical outcome in donors of right-lobe liver grafts. Transplantation. 2003;76:5–10.

  10. Haga J, Shimazu M, Wakabayashi G, et al. Liver regeneration in donors and adult recipients after living donor liver transplantation. Liver Transpl. 2008;14:1718–24.

  11. Aoki T, Imamura H, Matsuyama Y, et al. Convergence process of volumetric liver regeneration after living-donor hepatectomy. J Gastrointest Surg. 2011;15:1594–601.

  12. Kim SJ, Na GH, Choi HJ, You Y, Kim DG. Effect of donor right hepatectomy on splenic volume and platelet count for living donor liver transplantation. J Gastrointest Surg. 2013;17:1576–83.

    Article  PubMed  Google Scholar 

  13. Yokoi H, Isaji S, Yamagiwa K, et al. Donor outcome and liver regeneration after right-lobe graft donation. Transpl Int. 2005;18:915–22.

  14. 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;12:259–63.

    Article  PubMed  Google Scholar 

  15. Duclos J, Bhangui P, Salloum C, et al. Ad integrum functional and volumetric recovery in right lobe living donors: is it really complete 1 year after donor hepatectomy? Am J Transplant. 2016;16:143–56.

  16. Sakamoto T, Liu Z, Murase N, Ezure T, et al. Mitosis and apoptosis in the liver of interleukin-6–deficient mice after partial hepatectomy. Hepatology. 1999;29:403–11.

  17. Cattral MS, Molinari M, Vollmer CM Jr, et al. Living-donor right hepatectomy with or without inclusion of middle hepatic vein: comparison of morbidity and outcome in 56 patients. Am J Transplant. 2004;4:751–7.

  18. Yang HR, Jeng LB, Li PC, et al. Living donor right hepatectomy with inclusion of the middle hepatic vein: outcome in 200 donors. Transplant Proc. 2012;44:460–2.

  19. de Villa VH, Chen CL, Chen YS, et al. Right lobe living donor liver transplantation—addressing the middle hepatic vein controversy. Ann Surg. 2003;238:275–82.

  20. Fan ST, Lo CM, Liu CL, Yong BH, Chan JK, Ng IO. Safety of donors in live donor liver transplantation using right lobe grafts. Arch Surg. 2000;135:336–40.

    Article  PubMed  CAS  Google Scholar 

  21. Inomata Y, Uemoto S, Asonuma K, Egawa H. Right lobe graft in living donor liver transplantation. Transplantation. 2000;69:258–64.

    Article  PubMed  CAS  Google Scholar 

  22. Fujita S, Kim ID, Uryuhara K, et al. Hepatic grafts from live donors: donor morbidity for 470 cases of live donation. Transpl Int. 2000;13:333–9.

  23. Sakamoto S, Uemoto S, Uryuhara K, et al. Graft size assessment and analysis of donors for living donor liver transplantation using right lobe. Transplantation. 2001;71:1407–13.

  24. Ito T, Kiuchi T, Egawa H, et al. Surgery-related morbidity in living donors of right-lobe liver graft: lessons from the first 200 cases. Transplantation. 2003;76:158–63.

  25. Cho JY, Suh KS, Kwon CH, et al. Outcome of donors with a remnant liver volume of less than 35% after right hepatectomy. Liver Transpl. 2006;12:201–6.

  26. Nadalin S, Testa G, Malagó M, et al. Volumetric and functional recovery of the liver after right hepatectomy for living donation. Liver Transpl. 2004;10:1024–9.

  27. Rudow DL, Brown RS, Emond JC, Marratta D, Bellemare S, Kinkhabwala M. One-year morbidity after donor right hepatectomy. Liver Transpl. 2004;10:1428–31.

    Article  PubMed  Google Scholar 

  28. Ibrahim S, Chen CL, Wang CC, et al. Liver regeneration and splenic enlargement in donors after living-donor liver transplantation. World J Surg. 2005;29:1658–66.

Download references

Acknowledgements

We would like to express our gratitude and thanks to Dr. Agrima Gera, Dr. Nilesh Gumardhar, and Mr. Rahul Jadhav for their support till completion of this article.

Author information

Authors and Affiliations

Authors

Contributions

Study concept and protocol design, and initial draft for manuscript: SS and VK, data collection, and volumetric recovery data analysis; SS, SM, SS and KY. Critical revision of manuscript and intellectual content: SS, AC, VV, SK, and VK.

Corresponding author

Correspondence to Shailesh Anand Sable.

Ethics declarations

Conflict of interest

SS, SM, SS, KY, AC, SK, VV, and VK declare that they have no conflict of interest.

Ethics statement

The authors declare that the study was performed in a manner conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sable, S.A., Maheshwari, S., Sharma, S. et al. Kinetics of liver regeneration in donors after living donor liver transplantation: A retrospective analysis of “2/3rd partial hepatectomy” model at 3 months. Indian J Gastroenterol 37, 133–140 (2018). https://doi.org/10.1007/s12664-018-0838-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-018-0838-9

Keywords

  • Donor hepatectomy
  • Liver regeneration
  • Living donor liver transplant