Liver Regeneration and Factors Influencing Liver Regeneration in Donors and Recipients of Adult Living Donor Liver Transplantation Using Right Lobe Graft / 대한이식학회지

ABSTRACT

BACKGROUND: To balance between the appropriate remnant liver volume in the donors and sufficient graft volume in the recipients is very important in adult living donor liver transplantation (LDLT). The aim of this study is to evaluate the liver regeneration rate and the factors associated with the regenerative process in the donors and recipients. METHODS: Between May 1999 and March 2010, 197 donors and 98 recipients out of the 450 patients who underwent adult LDLT were evaluated retrospectively. We reviewed the clinical characteristics of the patients, liver regeneration using computerized tomography (CT)-assisted volumetry technique and the factors associated with liver regeneration in the donors and recipients. RESULTS: Using CT-assisted volumetry, the mean proportion of remnant right liver lobe was 62.4%+/-4.7%, ranging from 50.1% to 77.4%. The ratio of the graft weight to volume by CT-assisted volumetry was 89.8%+/-12.9% and we created a formula that graft volume (g)=[CT volume (mL)x0.933]+137.97. The liver regeneration rate in donors during the first postoperative week was higher if the remnant liver volume was below 35% than if the remnant liver volume above 35% (p<0.001). After 6 months, the remnant liver grew up to 81.2% of the original liver volume. Liver regeneration in recipients during the first postoperative week was faster if the graft-to-recipient body weight ratio (GRWR) was below 1% than if the GRWR was above 1% (p<0.001). Also, GRWR (p<0.001), portal vein (PV) velocity (cm/sec) (P=0.007) and PV flow volume per 100 g of graft tissue (mL/min) (P=0.002) were associated with liver regeneration in recipients during the early postoperative period by univariate analysis. CONCLUSIONS: The process of liver regeneration was most active during the first postoperative week in both the donors and recipients. The proportion of remnant liver in donors, GRWR and portal blood flow in recipients appeared to be the significant factors associated with liver regeneration.