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J Gastrointest Surg (2011) 15:15941601

DOI 10.1007/s11605-011-1590-y

ORIGINAL ARTICLE

Convergence Process of Volumetric Liver Regeneration

After Living-Donor Hepatectomy

Taku Aoki & Hiroshi Imamura & Yutaka Matsuyama &

Yoji Kishi & Takashi Kobayashi & Yasuhiko Sugawara &

Masatoshi Makuuchi & Norihiro Kokudo

Received: 23 March 2011 / Accepted: 10 June 2011 / Published online: 28 June 2011

# 2011 The Society for Surgery of the Alimentary Tract

Abstract

Background We investigated the long-term profiles of liver regeneration after living-donor hepatectomy.

Methods Thirty-three donors participated in the study. Preoperative and postoperative liver volume was calculated using computed tomography. Volume assessment was repeated at 1 week, 2 weeks, 1 month, 3 months, 6 months, 12 months, and 4 years postoperatively.

Results Donors were divided into the right (n=23; residual liver volume, 42%) and left (n=10; residual liver volume, 63%) groups according to the operative procedures. The restoration ratio to the preoperative liver volume (right vs. left groups) were 51%, 57%, 64%, 74%, 77%, 81%, and 88% vs. 69%, 72%, 76%, 79%, 83%, 84%, and 91% at 1 week, 2 weeks, 1 month, 3 months, 6 months, 12 months, and 4 years, respectively; the interindividual variation in the restoration ratio to the preoperative liver volume became narrower with time.

Conclusion Liver resection in humans resulted in rapid regeneration during the first 3 months, followed by a more moderate rate of regeneration thereafter, in proportion to the amount of liver mass resected. The volume of the regenerating liver appeared to converge towards the individual preoperative volume with time. However, the liver volume was not restored to the preoperative volume at 4 years after the resection.

Keywords CT volumetry. Donor hepatectomy. Liver regeneration . Total liver volume

T. Aoki : H. Imamura : Y. Kishi : T. Kobayashi : Y. Sugawara :

M. Makuuchi : N. Kokudo

Division of Hepato-Biliary-Pancreatic and Transplantation

Surgery, Department of Surgery, Graduate School of Medicine,

University of Tokyo,

Tokyo, Japan

Y. Matsuyama

Department of Biostatistics, Graduate School of Medicine,

University of Tokyo,

Tokyo, Japan

H. Imamura (*)

Department of Hepatobiliary-Pancreatic Surgery, Juntendo School of Medicine,

2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan

e-mail: himamura-tky@umin.ac.jp

Abbreviations

ALB

Albumin

LDLT

Living-donor liver transplantation

TLV

Total liver volume

CT

Computed tomography

ICG

Indocyanine green

BMI

Body mass index

TB

Total bilirubin

AST

Aspartate aminotransferase

ALT

Alanine aminotransferase

PT-INR

Prothrombin time international normalized ratio

ICG R15

ICG retention rate at 15 min

Introduction

Although the knowledge that the liver can regenerate after being deprived of its mass dates back to the ancient Greek myth of Prometheus, a scientific description of