Factors Affecting Liver Regeneration in Donors' Grafts in Living Donor Liver Transplant (LDLT) a Center Experience
Journal of Surgery
Volume 7, Issue 4, August 2019, Pages: 87-95
Received: May 14, 2019; Accepted: Jun. 23, 2019; Published: Jul. 2, 2019
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Authors
Morsi Mohamed, Hepato-Pancreatico-Biliary Unit, General Surgery Department, Zagazig University, Zagazig, Egypt
Wael Mansy, Hepato-Pancreatico-Biliary Unit, General Surgery Department, Zagazig University, Zagazig, Egypt
Osama Khalil, General Surgery Department, Zagazig University, Zagazig, Egypt
Yehia Attwa, Hepato-Pancreatico-Biliary Unit, General Surgery Department, Zagazig University, Zagazig, Egypt
Magdy Amin, Liver Transplant Unit in Hepato-Biliary Department, El-Maadi Armed Forces Hospital, Cairo, Egypt
Karim Boudjema, Hepato-Biliary Surgery and Liver Transplant Unit, Rennes University, Rennes, France
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Abstract
Background: Liver regeneration for donors' graft in living donor liver transplantation (LDLT), is an example for liver regeneration in normal liver. In this study we spotted the light on liver regeneration in donors after LDLT, focusing on factors affecting it. Aim: To study the impact of different factors on liver regeneration in donors of living donor liver transplantation. Patients and methods: Between May 2013 and June 2019, 80 living donor liver transplants were performed in the liver transplant unit in EL-Maadi Armed Forces Hospital. All donors who provided liver grafts underwent volumetric spiral computed tomography (CT) scans preoperatively and postoperatively at time intervals of 1 week and 1, 3 and 6 months. Patients’ demographics, surgical data, and postoperative outcomes were correlated with liver regeneration data. 63 patients were males and 17 patients were females, with mean age 27.97yrs ± 5.3. They provided {72} right lobe (RL) grafts and 8 right posterior sector (RP) grafts. Results: No donor operation was aborted and surgical morbidity rate was {33.75%}, mostly biliary. All RP donors achieved complete liver regeneration after 3 months; only four RL donors achieved complete liver regeneration at 6 months. Conclusion: In this study, it was found that there were factors affecting regeneration like age, gender of the patient and graft size. But no effect was found with many factors as peri-operative liver function tests, steatosis, BMI, operative time, blood loss, blood transfusion and postoperative complications.
Keywords
Liver Transplantation, Liver Regeneration, Living Donors
To cite this article
Morsi Mohamed, Wael Mansy, Osama Khalil, Yehia Attwa, Magdy Amin, Karim Boudjema, Factors Affecting Liver Regeneration in Donors' Grafts in Living Donor Liver Transplant (LDLT) a Center Experience, Journal of Surgery. Vol. 7, No. 4, 2019, pp. 87-95. doi: 10.11648/j.js.20190704.11
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
Kim WR, Lake JR, Smith JM, Skeans MA, Schladt DP, and Kasiske BL. OPTN/SRTR 2015 Annual data report: Liver. Am J Transplant 2017; S174. S251.
[2]
Trotter J: Living donor liver transplantation: is the hype over? J of hepato. 2005; 42 (1): 20-25.
[3]
Olthoff KM, Emond JC, Shearon TH, Everson G, Baker TB, Fisher RA, Freise CE, Gillespie BW and Everhart JE. Liver regeneration after living donor transplantation: Adult-to-adult living donor liver transplantation cohort study. Liver Transpl. 2015; 21: 79-88.
[4]
Gruttadauria S, Parikh V, Pagano D, Tuzzolino F, Cintorino D, Miraglia R, et al: Early regeneration of the remnant liver volume after right hepatectomy for living donation: a multiple regression analysis. Liver Transpl. 2012; 18: 907-913.
[5]
Chae MS, Moon KU, Chung HS, Park CS, Lee J, Choi JH, et al. Serum interleukin-6 and tumor necrosis-.factor are associated with early graft regeneration after living donor liver transplantation. PLoS One. 2018; 13: e0195262. https://doi.org/10.1371/journal.pone.0195262. PMID: 29649247.
[6]
Marcos A, Fisher R, Ham J, Shiffman M, Sanyal A, Luketic V, et al. Liver regeneration and function in donor and recipient after right lobe adult to adult living donor liver transplantation. Transpl. 2000; 69 (7): 1375-1379.
[7]
Botha J, Langnas A, Campos B, Grant W, Freise C, Ascher N, et al. Left lobe adult-to-adult living donor liver transplantation: small grafts and hemiportocaval shunts in the prevention of small for size syndrome. Liver Transpl. 2010; 16: 649-657.
[8]
Chen H, Chen C, Huang T, Chen T, Tsang L, Ou H, et al. Regeneration rate of left liver grafts in adult living donor liver transplant. Transplant Proc. 2010; 42: 699-700.
[9]
Zhang W, Tan Y, Shen S, Jiang L, Yan L, Yang J, Li B, Wen T, Zeng Y, Wang W and Xu M. Adult to adult right lobe living donor liver transplantation: Does biological relationship matter? Medicine (Baltimore). 2017; 96: e4139.
[10]
Kwon K, Kim Y, Kim S, Kim K, Lee W, Choi J. Postoperative liver regeneration and complication in live liver donor after partial hepatectomy for living donor liver transplantation. Yonsei medical j. 2003; 44 (6): 1069-1077.
[11]
Pomfret E, Pomposelli J, Gordon F, Erbay N, Price L, Lewis W, et al. Liver regeneration and surgical outcome in donors of right‐lobe liver grafts. Transpl. 2003; 76 (1): 5-10.
[12]
Kamel I, Erbay N, Warmbrand G, Kruskal J, Pomfret E, Raptopoulos V. Liver regeneration after living adult right lobe transplantation. Abdo imag. 2003; 28 (1): 0053-0057.
[13]
Wen T, Chen Z, Yan L, Li B, Zeng Y, Zhao J, et al. Measures for increasing the safety of donors in living donor liver transplantation using right lobe grafts. Hepatobiliary Pancreat Dis Int. 2007; 6 (6): 590-595.
[14]
Clavien P, Petrowsky H, DeOliveira M, Graf R. Strategies for safer liver surgery and partial liver transplantation. New England J. Med. 2007; 356 (15): 1545-1559.
[15]
Broelsch C, Malagó M, Testa G, Gamazo C. Living donor liver transplantation in adults: outcome in Europe. Liver Transpl. 2000; 6 (6B): s64-s65.
[16]
Olthoff K. Molecular pathways of regeneration and repair after liver transplantation. World j. surg. 2000; 26 (7): 831-837.
[17]
Fausto N. Liver regeneration: from laboratory to clinic. Liver transpl. 2001; 7 (10): 835-844.
[18]
Taub R. Liver regeneration: from myth to mechanism. Nature Reviews Molecular Cell Biology. 2004; 5 (10): 836-847.
[19]
Duclos J, Bhangui P, Salloum C, Andreani P, Saliba F, Ichai P, Elmaleh A, Castaing D and Azoulay D. 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: 143.156.
[20]
Eguchi S, Yanaga K, Sugiyama N, Okudaira S, Furui J, Kanematsu T. Relationship between portal venous flow and liver regeneration in patients after living donor right-lobe liver transplantation. Liver transpl. 2003; 9 (6): 547-551.
[21]
Chen H, Chen C, Huang T, Chen T, Tsang L, Ou H, et al. Regeneration rate of left liver grafts in adult living donor liver transplant. In Transplantation proc. 2010; 42 (3): 699-700.
[22]
Cheng Y, Huang T, Chen T, Tsang L, Ou H, Yu C, et al. Liver graft regeneration in right lobe adult living donor liver transplantation. American J. Transpl. 2009; 9 (6): 1382-1388.
[23]
Grewal H, Thistlewaite Jr J, Loss G, Fisher J, Cronin D, Siegel C, et al. Complications in 100 living-liver donors. Annals of surg. 1998; 228 (2): 214.
[24]
Schiano T, Kim‐Schluger L, Gondolesi G, Miller C. Adult living donor liver transplantation: the hepatologist's perspective. Hepato. 2001; 33 (1): 3-9.
[25]
Yokoi H, Isaji S, Yamagiwa K, Tabata M, Sakurai H, Usui M, et al. Donor outcome and liver regeneration after right lobe graft donation. Transplant international. 2005; 18 (8): 915-922.
[26]
Gruttadauria S, Parikh V, Pagano D, Tuzzolino F, Cintorino D, Miraglia R, et al. Early regeneration of the remnant liver volume after right hepatectomy for living donation: a multiple regression analysis. Liver Transpl. 2012; 18: 907–913.
[27]
Klink T, Simon P, Knopp C, Ittrich H, Fischer L, Adam G, et al. Liver remnant regeneration in donors after living donor liver transplantation: long-term follow-up using CT and MR imaging. RoFo. 2014; 186: 598–605.
[28]
Imamura H, Hidaka M, Soyama A, Kitasato A, Adachi T, Ono S, Natsuda K, Hara T, Kugiyama T, Baimakhanov Z, et al. A donor age based and graft volume based analysis for living donor liver transplantation in elderly recipients. Transplant Direct 2017; 3: e168.
[29]
Kubota T, Hata K, Sozu T, Ueda Y, Hirao H, Okamura Y. donor age on recipient survival in adult to adult living donor liver transplantation. Ann Surg 2018: 267: 1126-1133.
[30]
Tanemura A, Mizuno S, Wada H, Yamada T, Nobori T, Isaji S. Donor age affects liver regeneration during early period in the graft liver and late period in the remnant liver after living donor liver transplantation. World J Surg. 2012; 36: 1102–1111.
[31]
Hou C-T, Chen Y-L, Lin C-C, Chou C-T, Lin K-H, Lin P-Y, et al. Portal venous velocity affects liver regeneration after right lobe living donor hepatectomy. PLoS ONE. 2018; 13 (9): e0204163.
[32]
Kwon YJ, Lee KG, Choi D. Clinical implications of advances in liver regeneration. Clin Mol Hepatol. 2015; 21: 7±13. https://doi.org/10.3350/cmh.2015.21.1.7. PMID: 25834796.
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