Liver volume regeneration after living donor liver transplantation (LD/LDLTx) depends on segmental perfusion

Abstract

Background: The ability for liver volume regeneration after LD/LDLTx depends on liver morphology, function, perfusion and ischemia reperfusion injury. Methods: Donor and recipient, each n=42. Preoperative CT-volumetry in donors. Preoperative liverfunction test (LiMAx) for donor and recipient. LD: right hemihepatectomy (right-lobe graft, RLG). During LDLTx 3 liver biopsies were taken: 0-biopsy, from RL while ischemia and after reperfusion and stained with HMGB1. After LD and LDLTx on 2.POD LiMAx, on 10.POD and after 6 month (6M) CT-Volumetry and LiMAx were performed. Results: HMGB1-translocation, ischemia time and liver morphology were nearly same in all donors. Liver function in donors is restored on 10. POD (n=14), in recipients on 2. POD (n=14) and increased with 6M (n=10). Donor remnant liver gained after 6M to approx. 85% of total liver volume (n=12) an the RLG in recipients (adjusted to standard liver volume, SLV) gained to approx. 100% of SLV. Segmental volume regeneration (SVR) in RLG is mainly related to portal vein segments P7 and P8 and less P5. Regarding venous segments only perfusion region of right hepatic vein is gaining in contrast to more outflow obstructed perfusion areas of middle hepatic and inferior hepatic vein. In donors portal SVR takes place in P2 and P3, venous SVR occurs only via left hepatic vein. Conclusion: Liver volume regeneration maybe optimized by reduction of outflow obstruction respectively necessary hepatic vein reconstruction.