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Liver regeneration after living donor transplantation: adult-to-adult living donor liver transplantation cohort study.

ABSTRACT: 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?±?251 g (mean?±?SD), and percentage reconstitution was 80%?±?13%. Among recipients, GRWR was 1.3%?±?0.4% (8??0.90 for each). Both donors and recipients had rapid yet incomplete restoration of tissue mass in the first 3 months, and this confirmed previous reports. Recipients achieved a greater percentage of expected total volume. Patient size and recipient graft volume significantly influenced 3-month volumes. Importantly, donor liver volume is a critical predictor of the rate of regeneration, and donor remnant fraction affects postresection function. Liver Transpl 21:79-88, 2015. © 2014 AASLD.

SUBMITTER: Olthoff KM

PROVIDER: S-EPMC4276514 | biostudies-literature | 2015 Jan

REPOSITORIES: biostudies-literature

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Liver regeneration after living donor transplantation: adult-to-adult living donor liver transplantation cohort study.

Olthoff Kim M KM Emond Jean C JC Shearon Tempie H TH Everson Greg G Baker Talia B TB Fisher Robert A RA Freise Chris E CE Gillespie Brenda W BW Everhart James E JE

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 20141006 1

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) s ...[more]

PMID: 25065488

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Project description:Previous reports have drawn attention to persistently decreased platelet counts among liver donors. We hypothesized an etiologic association between altered platelet counts and postdonation splenomegaly and sought to explore this relationship. This study analyzed de-identified computed tomography/magnetic resonance scans of 388 donors from 9 Adult-to-Adult Living Donor Liver Transplantation Cohort Study centers read at a central computational image analysis laboratory. Resulting liver and spleen volumes were correlated with time-matched clinical laboratory values. Predonation liver volumes varied 2-fold in healthy subjects, even when they were normalized by the body surface area (BSA; range?=?522-1887 cc/m(2) , n?=?346). At month 3 (M3), postdonation liver volumes were, on average, 79% of predonation volumes [interquartile range (IQR)?=?73%-86%, n?=?165] and approached 88% at year 1 (Y1; IQR?=?80%-93%, n?=?75). The mean spleen volume before donation was 245 cc (n?=?346). Spleen volumes greater than 100% of the predonation volume occurred in 92% of donors at M3 (n?=?165) and in 88% at Y1 after donation (n?=?75). We sought to develop a standard spleen volume (SSV) model to predict normal spleen volumes in donors before donation and found that decreased platelet counts, a younger age, a higher predonation liver volume, higher hemoglobin levels, and a higher BSA predicted a larger spleen volume (n?=?344, R(2) ?=?0.52). When this was applied to postdonation values, some large volumes were underpredicted by the SSV model. Models developed on the basis of the reduced sample of postdonation volumes yielded smaller underpredictions. These findings confirm previous observations of thrombocytopenia being associated with splenomegaly after donation. The results of the SSV model suggest that the biology of this phenomenon is complex. This merits further long-term mechanistic studies of liver donors with an investigation of the role of other factors such as thrombopoietin and exposure to viral infections to better understand the evolution of the spleen volume after liver donation.

Dataset Information

Liver regeneration after living donor transplantation: adult-to-adult living donor liver transplantation cohort study.

Publications

Liver regeneration after living donor transplantation: adult-to-adult living donor liver transplantation cohort study.

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