Liver Remnant Regeneration in Donors After Living Donor Liver Transplantation: Long-Term Follow-Up Using CT and MR Imaging

Abstract

Purpose: To assess liver remnant volume regeneration and maintenance, and complications in the long-time follow-up of donors after living donor liver transplantation using CT and MRI. Materials and Methods: 47 donors with a mean age of 33.5 years who donated liver tissue for transplantation and who were available for follow-up imaging were included in this retrospective study. Contrast-enhanced CT and MR studies were acquired for routine follow-up.?Two observers evaluated pre- and postoperative images regarding anatomy and pathological findings. Volumes were manually measured on contrast-enhanced images in the portal venous phase, and potential postoperative complications were documented. Pre- and postoperative liver volumes were compared for evaluating liver remnant regeneration. Results: 47 preoperative and 89 follow-up studies covered a period of 22.4 months (range: 1???84). After right liver lobe (RLL) donation, the mean liver remnant volume was 522.0?ml (??144.0; 36.1?%; n?=?18), after left lateral section (LLS) donation 1,121.7?ml (??212.8; 79.9?%; n?=?24), and after left liver lobe (LLL) donation 1,181.5?ml (??279.5; 72.0?%; n?=?5). Twelve months after donation, the liver remnant volume were 87.3?% (RLL; ??11.8; n?=?11), 95.0?% (LS; ??11.6; n?=?18), and 80.1?% (LLL; ??2.0; n?=?2 LLL) of the preoperative total liver volume. Rapid initial regeneration and maintenance at 80?% of the preoperative liver volume were observed over the total follow-up period.?Minor postoperative complications were found early in 4 patients. No severe or late complications or mortality occurred. Conclusion: Rapid regeneration of liver remnant volumes in all donors and volume maintenance over the long-term follow-up period of up to 84 months without severe or late complications are important observations for assessing the safety of LDLT donors. Key Points: Liver remnant volumes of LDLT donors rapidly regenerated after donation and volumes were maintained over the long-term follow-up period of up to 84 months without severe or late complications. Citation Format: ??Klink T, Simon P, Knopp C et?al. Liver Remnant Regeneration in Donors After Living Donor Liver Transplantation: Long-Term Follow-Up Using CT and MR Imaging. Fortschr R?ntgenstr 2014; 186: 598???605

Long-Term Medical and Psychosocial Outcomes in Living Liver Donors

“…One report included serial assessments postdonation, and findings show that volume regeneration continues beyond the first year postdonation (25); this report showed that ultimately the regenerated liver volumes in the vast majority of assessments were indistinguishable from preoperative volumes. The two additional long-term cross-sectional follow-up studies also found little to no pre- versus postdonation mean differences in total volumes (10,26).…”

“…The two additional long-term cross-sectional follow-up studies also found little to no pre- versus postdonation mean differences in total volumes (10,26). No differences were noted in late-term total volume as a function of type of graft donated (10,25). However, samples in the studies were relatively small (Table 2), limiting any ability to identify graft-related differences.…”

“…Three single-site reports compare predonation MRI or computed tomography scans with postdonation scans from up to 12 years postdonation in order to examine liver volume regeneration (10,25,26). One report included serial assessments postdonation, and findings show that volume regeneration continues beyond the first year postdonation (25); this report showed that ultimately the regenerated liver volumes in the vast majority of assessments were indistinguishable from preoperative volumes.…”

Hepatic Radioembolization as a Bridge to Liver Surgery

“…In a study by Klink et al, after donation of a right liver lobe, the remaining left lobe had a mean volume of 36.1% of the TLV (baseline) (89). After 1 month, FRL was 54.8% of the pre-transplantation TLV (53.6% DoH).…”

“…After 1 month, FRL was 54.8% of the pre-transplantation TLV (53.6% DoH). After 3 months, 80% of the pre-transplantation TLV was restored (146% DoH) and after 12 months the post-transplantation volume was equal to or even more than 100% of the initial TLV (267% DoH) (89). This shows the value of a longer interval between the induction of hypertrophy and surgery.…”