Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi-70, India.
Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi-70, India.
J Gastrointest Surg. 2020 Aug;24(8):1818-1826. doi: 10.1007/s11605-019-04332-8. Epub 2019 Aug 6.
Regeneration of the remnant liver in early postoperative period determines the outcome in live liver donors (LLDs). The aim of the current study is to evaluate the factors that influence liver regeneration following live donor hepatectomy.
Total liver volume (TLV), estimated graft volume (EGV), and remnant liver volume (RLV) were calculated preoperatively in a prospective study of 154 LLDs. Absolute and percentage growth of remnant liver (regeneration index) in donor was estimated at 7th postoperative day (POD) by computed tomography (CT) volumetric analysis.
One hundred eighteen donors underwent right hepatectomy (RH), 29 underwent left hepatectomy (LH), 6 donors had left lateral sectionectomy (LLS), and one had right posterior sectionectomy. The median percentage growth of remnant liver at the end of the first week was 46.14% (51.74%, 35.32%, and 17.38% for RH, LH, and LLS, respectively). On univariate analysis, female donors (p = 0.051), RH graft (p = 0.001), no steatosis on ultrasonography (p = 0.042), lower TLV (p = 0.029), RLV (p = < 0.001), RLV-to-body weight ratio (RLVBWR) (p = < 0.001), preoperative alanine aminotransferase (ALT) level (p = 0.017), aspartate aminotransferase (AST) (p = 0.035) and higher POD 7 alkaline phosphatase (ALP) (p = 0.033), and POD 7 gamma-glutamyl transferase GGT (p = 0.006) were found to be predictors of greater liver regeneration. Among them, lower RLV (P = 0.008), RLVBWR (p = 0.011), and preoperative ALT level (p = 0.021) were most significant factors predictive of liver regeneration on logistic regression analysis with backward elimination.
The liver regenerates rapidly in LLDs following hepatectomy. Low RLV, RLVBWR, and preoperative ALT levels were predictors of liver regeneration in the first week following donor hepatectomy.
残肝在术后早期的再生情况决定了活体肝供者（LLD）的预后。本研究旨在评估活体肝切除术后影响肝再生的因素。
前瞻性研究 154 例 LLD，术前计算总肝体积（TLV）、估计供肝体积（EGV）和残肝体积（RLV）。术后第 7 天通过 CT 容积分析计算供肝残肝的绝对和百分比生长（再生指数）。
118 例供者行右半肝切除术（RH），29 例行左半肝切除术（LH），6 例行左外叶切除术（LLS），1 例行右后叶切除术。第 1 周末残肝的中位百分比生长为 46.14%（RH、LH 和 LLS 分别为 51.74%、35.32%和 17.38%）。单因素分析显示，女性供者（p=0.051）、RH 供肝（p=0.001）、超声检查无脂肪变性（p=0.042）、TLV 较低（p=0.029）、RLV（p<0.001）、RLV 与体重比（RLVBWR）（p<0.001）、术前丙氨酸转氨酶（ALT）水平（p=0.017）、天冬氨酸转氨酶（AST）（p=0.035）和第 7 天碱性磷酸酶（ALP）较高（p=0.033）以及第 7 天γ-谷氨酰转移酶（GGT）（p=0.006）是肝再生较大的预测因子。其中，RLV 较低（P=0.008）、RLVBWR 较低（p=0.011）和术前 ALT 水平较低（p=0.021）是术后第 1 周肝再生的最显著预测因素，Logistic 回归分析向后消除法显示。
肝切除术后 LLD 肝快速再生。RLV、RLVBWR 和术前 ALT 水平是供肝切除术后第 1 周肝再生的预测因素。
