Donor Age Affects Liver Regeneration during Early Period in the Graft Liver and Late Period in the Remnant Liver after Living Donor Liver Transplantation

Abstract

Background The aim of the present study was to evaluate the influence of donor age on liver regeneration and surgical outcomes in recipients and donors. Patients and methods Among 101 cases of adult‐to‐adult living donor liver transplantation (LDLT) between March 2002 and March 2011, according to donor age: younger (Y) <50 years of age or older (O) ≥50 years of age, the donors and recipients using right (R) or left (L) graft were divided into groups Y/R (n = 51) and O/R (n = 17), and groups Y/L (n = 26) and O/L (n = 7), respectively. Remnant liver volume (RemLV) and graft liver volume (GLV) were estimated by computed tomography (CT) volumetry. A disintegrin and metalloprotease with thrombospondin type I domain 13 (ADAMTS13) activities and von Willebrand factor (vWF) antigen levels were measured as factors reflecting thrombotic microangiopathy. Results Among the donors, RemLV/total liver volume (TLV) was lower in group O/R than in group Y/R, although there were no significant differences by t‐test with the Bonferroni correction (rough p value = 0.02 at 6 months and rough p value > 0.05 at 1, 3, and 12 months). Donor age (≥50 years) was independently correlated with impaired remnant liver regeneration at 6 months in right lobe LDLT (p = 0.04). Among the recipients, GLV/standard liver volume (SLV) was lower during the first month, although there were no significant differences between the two groups by t‐test with the Bonferroni correction (rough p value = 0.03 at 1 week and rough p value >0.05 at 2 weeks and 1 and 3 months). Donor age (≥50 years) was independently correlated with impaired graft liver regeneration at 1 week in both right and left lobe LDLT (p < 0.05). ADAMTS13 activities were lower in group O/R than in group Y/R, although there were no significant differences by t‐test with the Bonferroni correction (rough p value = 0.049 on postoperative days (POD) 1 and 28 and rough p value >0.05 on POD 7 and 14). vWF/ADAMTW13 ratios were higher on POD 14, although there were no significant differences between the two groups by t‐test with the Bonferroni correction (rough p value = 0.044 on POD 14 and rough p value >0.05 on POD 1, 7, 14, and 28). Conclusions The surgical outcomes using older donor livers for LDLT were comparable to those using younger donor livers. When using older donor livers, however, we should pay attention to the liver volume for recipients as well as donors, because older donor livers might have impaired regenerative ability.

Ad Integrum Functional and Volumetric Recovery in Right Lobe Living Donors: Is It Really Complete 1 Year After Donor Hepatectomy?

“…In most other studies, incomplete liver regeneration was reported even up to 4 years after donation (33). Regarding factors influencing regeneration, some studies have suggested that age had an impact on regeneration (25,30,41), while several other studies showed that there was no impact of donor age on liver regeneration (16,27,33,38,45). We did find that increasing donor age had a negative influence on early as well as late volumetric recovery (on POD7 and POD365).…”

Predictors of renal recovery in patients with pre-orthotopic liver transplant (OLT) renal dysfunction

“…For example, our study concurs with others in showing a worse outcome with the use of older donors [5,21,22] (Tables 8 and 9). While the mechanism for the detrimental effect of older donor age on renal recovery is not fully understood, a slower onset of hepatic allograft function may be contributory [23,24]. There is also evidence that the livers from older donors are at greater risk for ischemia-reperfusion injury [25-27], although there is no universal agreement on this point [28].…”

Senescence‐related genes possibly responsible for poor liver regeneration after hepatectomy in elderly patients

“…Methods of treatment include liver transplantation and liver resection, with liver regeneration making extensive liver resection or living donor liver transplantation possible. Several donor‐associated factors may affect liver regeneration after transplantation, including donor age, ischemic injury, and graft size . The loss of regenerative capacity is the most dramatic age‐associated alteration of preserved livers .…”