Zhang Yuling, Li Bei, He Qing, Chu Zhiqiang, Ji Qian
The First Central Clinical School, Tianjin Medical University, Nankai District, Tianjin, China.
Department of Radiology, Tianjin First Central Hospital, Nankai District, Tianjin, China.
Quant Imaging Med Surg. 2022 Jun;12(6):3184-3192. doi: 10.21037/qims-21-1077.
Living-donor liver transplantation (LDLT) is recognized as the standard treatment for end-stage liver diseases. The regeneration of the residual liver and graft after LDLT is important in evaluating surgical success. Previous studies have attempted to elucidate mechanisms, principles of liver regeneration after LDLT, or influencing factors. However, they have not ruled out patients with complications and reached a uniform conclusion. In this study, for the first time, we unified measurement methods of liver volumes and eliminated patients with complications to compare liver regeneration trends between donors and recipients after LDLT and search for potential influencing factors.
A total of 61 donors and 62 recipients without complications after adult right lobe LDLT were included in this retrospective observational cohort study. The liver regeneration ratios (LRRs) at different time points in donors and recipients after LDLT were calculated and compared. Factors that affect LRRs include gender, age, graft with or without the middle hepatic vein (MHV), initial remnant liver (IRLV)/estimated standard liver volume (ESLV), initial graft volume (IGV)/ESLV, Child-Pugh grade, and model for end-stage liver disease (MELD) score of the recipients. Analysis of variance, independent-sample -test, and correlation analysis were performed for statistical analyses.
Significant differences were found in LRRs between the donors and recipients after LDLT (all P<0.05). The LRRs of donors at 0.5, 1, 3, and 6 months were 80.80%±24.12% (72.87%, 88.73%), 98.62%±37.47% (75.97%, 121.26%), 103.34%±23.47% (83.73%, 122.96%), and 130.18%±17.68% (102.04%, 158.32%), respectively. The LRRs of recipients at 0.5, 1, 3, and 6 months were 58.49%±26.67% (49.04%, 67.95%), 50.16%±27.25% (40.94%, 59.38%), 44.36%±26.75% (35.30%, 53.41%), and 31.19%±22.57% (20.91%, 41.47%), respectively. The former values were higher than the latter. The LRRs of recipients with the MHV was higher than those without MHV at 1 and 3 months (P<0.05). The LRRs at 1 month were 59.63%±27.48% and 41.68%±24.73%, and at 3 months were 57.25%±25.42% and 32.81%±22.79%, respectively. The IRLV/ESLV and IGV/ESLV were negatively correlated with LRRs at several times [r=-0.419 (-0.646, -0.134), -0.608 (-0.832, -0.318), respectively; P<0.05]. At 0.5 month, significant difference was found between Child-Pugh score of ≤9.55 and >9.55 (P<0.05) and MELD score of ≤14 and >14 (P<0.05).
After LDLT, donors had more significant and faster liver regeneration than the recipients. Graft with or without MHV, initial liver volume, and preoperative liver function status of the recipients significantly affect liver regeneration.
活体肝移植（LDLT）被公认为终末期肝病的标准治疗方法。LDLT术后残余肝脏和移植肝的再生对于评估手术成功与否至关重要。以往的研究试图阐明LDLT术后肝脏再生的机制、原则或影响因素。然而，这些研究并未排除有并发症的患者，也未得出统一结论。在本研究中，我们首次统一了肝脏体积的测量方法，并排除了有并发症的患者，以比较LDLT术后供体和受体的肝脏再生趋势，并寻找潜在的影响因素。
本回顾性观察队列研究纳入了61例成人右叶LDLT术后无并发症的供体和62例受体。计算并比较了LDLT术后供体和受体在不同时间点的肝脏再生率（LRR）。影响LRR的因素包括性别、年龄、有无肝中静脉（MHV）的移植物、初始残余肝（IRLV）/估计标准肝体积（ESLV）、初始移植物体积（IGV）/ESLV、Child-Pugh分级以及受体的终末期肝病模型（MELD）评分。采用方差分析、独立样本t检验和相关分析进行统计学分析。
LDLT术后供体和受体的LRR存在显著差异（所有P<0.05）。供体在0.5、1、3和6个月时的LRR分别为80.80%±24.12%（72.87%，88.73%）、98.62%±37.4%（75.97%，121.26%）、103.34%±23.47%（83.73%，122.96%）和130.18%±17.68%（102.04%，158.32%）。受体在0.5、1、3和6个月时的LRR分别为58.49%±26.67%（49.04%，67.95%）、50.16%±27.25%（40.94%，59.38%）、44.36%±26.75%（35.30%，53.41%）和31.19%±22.57%（20.91%，41.47%）。前者的值高于后者。有MHV的受体在1个月和3个月时的LRR高于无MHV的受体（P<0.05）。1个月时分别为59.63%±27.48%和41.68%±24.73%，3个月时分别为57.25%±25.42%和32.81%±22.79%。IRLV/ESLV和IGV/ESLV在多个时间点与LRR呈负相关[r分别为-0.419（-0.646，-0.134）、-0.608（-0.832，-0.318）；P<0.05]。在0.5个月时，Child-Pugh评分≤9.55和>9.55之间（P<0.05）以及MELD评分≤14和>14之间（P<0.05）存在显著差异。
LDLT术后，供体的肝脏再生比受体更显著、更快。有无MHV的移植物、初始肝脏体积以及受体的术前肝功能状态显著影响肝脏再生。
