title: Functional elements associated with hepatic regeneration in living donors after right hepatic lobectomy.
abstract: We quantified the rates of hepatic regeneration and functional recovery for 6 months after right hepatic lobectomy in living donors for liver transplantation. Twelve donors were studied pre-donation (baseline); 8 were retested at a mean ± SD of 11±3 days after donation (T1), 10 were retested at a mean of 91±9 days after donation (T2), and 10 were retested at a mean of 185±17 days after donation (T3). Liver and spleen volumes were measured with computed tomography (CT) and single-photon emission computed tomography (SPECT). Hepatic metabolism was assessed with caffeine and erythromycin, and hepatic blood flow (HBF) was assessed with cholates, galactose, and the perfused hepatic mass (PHM) by SPECT. The regeneration rates (mL kg(-1) of body weight day(-1)) by CT were 0.60±0.22 mL from the baseline to T1, 0.05±0.02 mL from T1 to T2, and 0.01±0.01 from T2 to T3; by SPECT they were 0.54±0.20, 0.04±0.01, and 0.01±0.02, respectively. At T3, the liver volumes were 84%±7% of the baseline according to CT and 92%±13% of the baseline according to SPECT. Changes in the hepatic metabolism did not achieve statistical significance. At T1, the unadjusted clearance ratios with respect to the baseline were 0.75±0.07 for intravenous cholate (P<0.001), 0.88±0.15 for galactose (P=0.07), 0.84±0.08 for PHM (P=0.002), and 0.83±0.19 for the estimated HBF (P=0.06). At T1, these ratios adjusted per liter of liver were up to 50% greater than the baseline values, suggesting recruitment of HBF by the regenerating liver. Increased cholate shunt, increased spleen volume, and decreased platelet count, were consistent with an altered portal circulation. In conclusion, initial hepatic regeneration is rapid, accounts for nearly two-thirds of total regeneration, and is associated with increases in HBF and cholate uptake. Right lobe donation alters the portal circulation of living donors, but the long-term clinical consequences, if there are any, are unknown.
authors.affiliation: Section of Hepatology, Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, CO 80045, USA. greg.everson@ucdenver.edu
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Everson
authors.forename: John C
authors.initials: JC
authors.lastname: Hoefs
authors.forename: Claus U
authors.initials: CU
authors.lastname: Niemann
authors.forename: Kim M
authors.initials: KM
authors.lastname: Olthoff
authors.forename: Robert
authors.initials: R
authors.lastname: Dupuis
authors.forename: Shannon
authors.initials: S
authors.lastname: Lauriski
authors.forename: Andrea
authors.initials: A
authors.lastname: Herman
authors.forename: Norah
authors.initials: N
authors.lastname: Milne
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Gillespie
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Goodrich
authors.forename: James E
authors.initials: JE
authors.lastname: Everhart
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001944:Breath Tests; D002110:Caffeine / Q000097:blood; D020355:Cholates / Q000097:blood; D003120:Colorado; D004917:Erythromycin / Q000378:metabolism; D005260:Female; D006498:Hepatectomy; D006801:Humans; D019934:International Normalized Ratio; D016014:Linear Models; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*; D008102:Liver Circulation; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012495:San Francisco; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C422455:ALB protein, human; D020355:Cholates; D012709:Serum Albumin; D002110:Caffeine; D004917:Erythromycin; D000410:Alanine Transaminase; D001663:Bilirubin; D000075462:Serum Albumin, Human