Liver regeneration after living donor transplantation: Adult-to-adult living donor liver transplantation cohort study (original) (raw)

Adult-to-adult living donors and recipients were studied to characterize patterns of liver growth and identify associated factors in a multicenter study. Three hundred and fifty donors and 353 recipients in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) receiving transplants between March 2003 and February 2010 were included. Potential predictors of 3-month liver volume included total and standard liver volumes (TLV and SLV), Model for End-Stage Liver Disease (MELD) score (in recipients), the remnant and graft size, remnant-to-donor and graft-to-recipient weight ratios (RDWR and GRWR), remnant/TLV, and graft/SLV. Among donors, 3-month absolute growth was 676 6 251 g (mean 6 SD), and percentage reconstitution was 80% 6 13%. Among recipients, GRWR was 1.3% 6 0.4% (8 < 0.8%). Graft weight was 60% 6 13% of SLV. Three-month absolute growth was 549 6 267 g, and percentage reconstitution was 93% 6 18%. Predictors of greater 3-month liver volume included larger patient size (donors and recipients), larger graft volume (recipients), and larger TLV (donors). Donors with the smallest remnant/TLV ratios had larger than expected growth but also had higher postoperative bilirubin and international normalized ratio at 7 and 30 days. In a combined donor-recipient analysis, donors had smaller 3-month liver volumes than recipients adjusted for patient size, remnant or graft volume, and TLV or SLV (P 5 0.004). Recipient graft failure in the first 90 days was predicted by poor graft function at day 7 (HR 5 4.50, P 5 0.001)