Kim Na Reum, Choi Gi Hong, Choi Jin Sub, Han Dai Hoon
Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2025 Jul;109(1):27-34. doi: 10.4174/astr.2025.109.1.27. Epub 2025 Jul 2.
Given the widening of the donor pool to include patients with steatosis, small-for-size grafts, and older patients, this study examined the effect of age on liver volumetric regeneration after a donor right hepatectomy.
We enrolled 33 older (≥55 years) and 277 younger (<30 years) donors who underwent donor right hepatectomy between March 2012 and December 2022. After propensity score-matched analysis, the perioperative surgical outcomes and growth rates of the remnant liver in 63 younger and 32 older donors were compared. Liver regeneration was assessed using CT volumetry for up to 6 months after surgery. Poor liver regeneration was defined as restoration of less than 80% of the original liver volume. The risk factors for poor liver regeneration were analyzed using a binary logistic regression model.
The mean age of older and younger donors was 58.0 and 24.3 years, respectively. Despite comparable preoperative factors, older donors showed significantly lower regeneration rates at all observed time points (1 month: 75.5% 82.3%, P = 0.001; 3 months: 80.4% 90.5%, P < 0.001; and 6 months: 87.9% 95.8, P = 0.006, compared to total liver volume). A large total liver volume and older age were identified as risk factors for poor liver regeneration.
Older donors showed a reduced capacity for liver regeneration. This finding suggests the need for the development of more conservative criteria for residual liver volume in older donors than for younger donors to ensure donor safety.
鉴于供体库的扩大，纳入了脂肪变性患者、小体积供肝患者和老年患者，本研究探讨了年龄对供体右半肝切除术后肝脏体积再生的影响。
我们纳入了2012年3月至2022年12月期间接受供体右半肝切除术的33例老年（≥55岁）供体和277例年轻（<30岁）供体。经过倾向评分匹配分析后，比较了63例年轻供体和32例老年供体的围手术期手术结局和残余肝脏的生长率。术后长达6个月使用CT容积测量法评估肝脏再生情况。肝脏再生不良定义为肝脏体积恢复不到原始肝脏体积的80%。使用二元逻辑回归模型分析肝脏再生不良的危险因素。
老年供体和年轻供体的平均年龄分别为58.0岁和24.3岁。尽管术前因素相当，但老年供体在所有观察时间点的再生率均显著较低（与全肝体积相比，1个月时：75.5%对82.3%，P = 0.001；3个月时：80.4%对90.5%，P < 0.001；6个月时：87.9%对95.8%，P = 0.006）。全肝体积大以及年龄大被确定为肝脏再生不良的危险因素。
老年供体的肝脏再生能力降低。这一发现表明，需要制定比年轻供体更保守的老年供体残余肝体积标准，以确保供体安全。
