Elsevier

Surgery

Volume 150, Issue 2, August 2011, Pages 154-161
Surgery

Society of University Surgeons
The influence of donor age on liver regeneration and hepatic progenitor cell populations

https://doi.org/10.1016/j.surg.2011.05.004Get rights and content

Background

Recent reports suggest that donor age might have a major impact on recipient outcome in adult living donor liver transplantation (LDLT), but the reasons underlying this effect remain unclear. The aims of this study were to compare liver regeneration between young and aged living donors and to evaluate the number of Thy-1+ cells, which have been reported to be human hepatic progenitor cells.

Methods

LDLT donors were divided into 2 groups (Group O, donor age ≥ 50 years, n = 6 and Group Y, donor age ≤ 30 years, n = 9). The remnant liver regeneration rates were calculated on the basis of computed tomography volumetry on postoperative days 7 and 30. Liver tissue samples were obtained from donors undergoing routine liver biopsy or patients undergoing partial hepatectomy for metastatic liver tumors. Thy-1+ cells were isolated and counted using immunomagnetic activated cell sorting (MACS) technique.

Results

Donor liver regeneration rates were significantly higher in young donors compared to old donors (P = .042) on postoperative day 7. Regeneration rates were significantly higher after right lobe resection compared to rates after left lobe resection. The MACS findings showed that the number of Thy-1+ cells in the human liver consistently tended to decline with age.

Conclusion

Our study revealed that liver regeneration is impaired with age after donor hepatectomy, especially after right lobe resection. The declining hepatic progenitor cell population might be one of the reasons for impaired liver regeneration in aged donors.

Section snippets

Grouping and donor characteristics

LDLT donors from January 2005 to December 2009 were retrospectively reviewed and divided into 2 groups (Group O, donor age ≥ 50 years, n = 6 and Group Y, donor age ≤ 30 years, n = 9) (Table 1). In Group Y, all the donors were men (age: 21–29 years), whereas in Group O, there were 3 men and 3 women donors (age: 50–65 years). The graft types comprised 5 right lobes without the middle hepatic vein (MHV) and 10 left lobes with the MHV. The postoperative courses of all donors were uneventful.

Evaluation of liver regeneration

Remnant

Donor liver regeneration rate

Interestingly, the RR value on POD 7 was significantly higher in Group Y than in Group O (Group Y, 1.22, vs Group O, 1.06; P = .027) (Fig 1, A). The RR value of the right lobe donor group was higher than that of the left lobe donor group (Fig 1, B). A subgroup analysis demonstrated that the RR value of the both right and left lobe donor group was higher in Group Y compared to Group O on POD 7. No significant difference was noted in the RR value between Group O and Y on POD 30 in either the

Discussion

Donor hepatectomy is the only procedure that injures the normal liver; therefore, investigation of liver regeneration after donor hepatectomy is the best and most accurate approach to elucidate the timeline of liver regeneration in a clinical setting.

Previous studies have shown that the mean liver volume 6 months after donor hepatectomy was 90.7% of the initial liver volume,17 and that the livers of the right lobe donor group regenerated faster than those of the left lobe donor group.18 Our

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    Supported by a Ministry of Education, Culture, Sports, Science and Technology Grant-in-Aid for Scientific Research (C) (#21591763, S.K.).

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