Liver regeneration and function in donor and recipient after right lobe adult to adult living donor liver transplantation.
BACKGROUND
Regeneration of the liver to a predetermined size after resection or transplantation is a well described phenomenon, but the time course over which these events occur has not been well defined. It is not clear how initial liver mass, reperfusion, immunosuppression, or steatosis influence this process.


METHODS
Liver regeneration was assessed prospectively by volumetric magnetic resonance imaging (MRI) in living right lobe liver donors and the recipients of these grafts. Imaging was performed at regular intervals through 60 days after resection/transplantation, and liver mass was determined. Liver function tests and synthetic function were monitored throughout the study period in donors and recipients of these grafts as well as recipients of cadaveric grafts.


RESULTS
MRI consistently overestimated liver mass by a mean of 45 g (+/-65) (range 10-123). Donor liver mass increased by 101%, 110%, 115%, and 144% at 7, 14, 30, and 60 days after resection, respectively. Recipient liver mass increased by 87,101, 119, and 99% at 7, 14, 30, and 60 days after transplantation, respectively. Steatosis did not influence the degree of regeneration or graft function, nor was there a functional difference between grafts of >1% graft to recipient body weight ratio or <1%.


CONCLUSIONS
MRI accurately determines right lobe mass. Most liver regeneration occurs in the 1st week after resection or transplantation, and the time course does not differ significantly in donors or recipients. The mass of the graft or remnant segment affects the duration of the regeneration process, with a smaller initial liver mass prolonging the course. Steatosis of <30% had no bearing on liver function or regeneration and, therefore, should not be an absolute criterion for exclusion of donors. A calculated graft to recipient body weight ratio of 0.8% is adequate for right lobe living donor liver transplantation.
Marcos
A
A
Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond 23219, USA.
Fisher
R A
RA
Ham
J M
JM
Shiffman
M L
ML
Sanyal
A J
AJ
Luketic
V A
VA
Sterling
R K
RK
Fulcher
A S
AS
Posner
M P
MP
D000328:Adult; D001835:Body Weight; D005234:Fatty Liver / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000473:pathology / Q000503:physiopathology*; D008115:Liver Regeneration; D016031:Liver Transplantation; D019520:Living Donors; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies