Liver regeneration after living donor liver transplantation (LDLT).

Purpose We aim to identify possible factors affecting liver regeneration in donors, liver graft hypertrophy and spleen shrinkage in recipients. We aim also to assess the differences between donors and recipients.Methods and methodsTwenty-seven donors and 27 recipients were included. We collected anthropometric and bio-humoral parameters considered in the preoperative setting, just after the surgery, after 7 days, and after 30 days from the surgery. We calculated liver regeneration rates (RR%), regeneration velocities (RV) and spleen reduction rates (SRR%) at 2-3 months, 12 months, and 24 months. Body composition parameters were calculated.ResultsIn right lobe donors we found a mean RR of 118,70%, 146,33% and 154,88%. The mean RV was 7,94 cc/s, 0,61 cc/s, and 0,24 cc/s.For right lobe recipients the mean RR was 72,61%, 68,31%, and 79,69%. The mean RV was 9,74 cc/s, 0,19 cc/s, and 0,16 cc/s. The mean spleen reduction rate was 1,38%, 11,36%, and 10,80%.The regeneration rates were higher in donors with statistically significant differences. The recipients have a growth peak within 2-3 months, while donors at 12 months.In donors, the residual liver volume after transplantation and pre-transplant liver function are negatively correlated with regeneration. In recipients, we observed negative correlations with hematological and nutritional parameters. Liver regeneration goes parallel with the volumetric reduction of the spleen. A greater muscle mass and improved muscle quality are major stimuli to the regeneration process.ConclusionThis study emphasizes how sophisticated and versatile liver regeneration is, influenced not only by the remaining liver or graft, but also by the metabolic environment of the host.