Pomfret Elizabeth A, Pomposelli James J, Gordon Fredric D, Erbay Nazli, Lyn Price Lori, Lewis W David, Jenkins Roger L
Division of Liver Transplantation and Hepatobiliary Surgery, Lahey Clinic Medical Center, Burlington MA 01805, USA. Elizabeth.A.Pomfret@ lahey.org.
Transplantation. 2003 Jul 15;76(1):5-10. doi: 10.1097/01.TP.0000079064.08263.8E.
Previous studies of healthy live-liver donors have suggested that complete liver regeneration occurs within a matter of weeks; however, there have been no long-term studies evaluating liver regeneration and few studies documenting long-term donor outcome.
Fifty-one donors who provided right-lobe grafts underwent volumetric spiral computed tomography scans preoperatively and postoperatively at time intervals of 1 week and 1, 3, 6, and 12 months. Patient demographics, surgical data, and postoperative outcome were correlated with liver regeneration data. Donor surgical outcome was followed prospectively and recorded in a comprehensive database.
Thirty-three males and 18 females (mean age 36.0+/-9.6 years) provided 51 right-lobe grafts. Mean follow-up was 9.8+/-3.4 months. No donor operation was aborted, and surgical morbidity and mortality rates were 39% and 0%, respectively. Donor remnant liver volume was 49.4+/-5.7% of the original total liver volume (TLV). Overall liver regeneration was 83.3+/-9.0% of the TLV by 1 year. Female donors had significantly slower liver regrowth when compared with males at 12 months (79.8+/-9.3% vs. 85.6+/-8.2%, P<0.01). There was no effect of age, body mass index, operative time, estimated blood loss, postoperative complications, or perioperative liver function tests on liver regeneration.
Liver regeneration continues throughout the first postoperative year. Only one donor achieved complete liver regeneration during this time period; however, all donors have maintained normal liver function without long-term complications. Longer follow-up is needed to determine whether donors ever achieve original TLV.
先前对健康活体肝供体的研究表明，肝脏在数周内即可完全再生；然而，尚无长期研究评估肝脏再生情况，且鲜有研究记录供体的长期结局。
51例提供右叶移植物的供体在术前以及术后1周、1、3、6和12个月时接受了容积螺旋计算机断层扫描。将患者人口统计学资料、手术数据和术后结局与肝脏再生数据进行关联分析。对供体手术结局进行前瞻性随访，并记录在一个综合数据库中。
33例男性和18例女性（平均年龄36.0±9.6岁）提供了51个右叶移植物。平均随访时间为9.8±3.4个月。没有供体手术中途取消，手术并发症发生率和死亡率分别为39%和0%。供体残余肝体积为原全肝体积（TLV）的49.4±5.7%。到1年时，总体肝脏再生量为TLV的83.3±9.0%。在12个月时，女性供体的肝脏再生明显慢于男性（79.8±9.3%对85.6±8.2%，P<0.01）。年龄、体重指数、手术时间、估计失血量、术后并发症或围手术期肝功能检查对肝脏再生均无影响。
肝脏再生在术后第一年持续进行。在此期间只有1例供体实现了肝脏完全再生；然而，所有供体均维持了正常肝功能，且无长期并发症。需要更长时间的随访来确定供体是否能恢复至原全肝体积。
