Korean J Transplant.  2022 Dec;36(4):259-266. 10.4285/kjt.22.0039.

Impact of the preoperative skeletal muscle index on early remnant liver regeneration in living donors after liver transplantation

• Lee S
• Kim KW
• Kwon HJ
• Lee J
• Song GW
• Lee SG

• KMID: 2537537
• DOI: http://doi.org/10.4285/kjt.22.0039

Abstract

Background
We investigated the correlation between the preoperative skeletal muscle index (SMI) and remnant liver regeneration after right hemihepatectomy for living-donor liver transplantation and aimed to identify preoperative predictors of greater early remnant liver regeneration in living donors.
Methods
This retrospective study included 525 right hemiliver donors (mean age, 28.9±8.3 years; 345 male patients) between 2017 and 2018, who underwent computed tomography before surgery and on postoperative day (POD) 7. Preoperative anthropometry, laboratory parameters, skeletal muscle area at the third lumbar vertebral level, and liver volume before and after surgery were evaluated. Correlations were analyzed using Pearson correlation coefficients, and stepwise multiple regression analysis was performed to identify independent predictors of greater remnant liver regeneration.
Results
Remnant liver regeneration volume on POD 7 was positively correlated with body mass index (BMI; r=0.280, P<0.001) and SMI (r=0.322, P<0.001), and negatively correlated with age (r=–0.154, P<0.001) and the ratio of future remnant liver volume (FRLV) to total liver volume (TLV; r=–0.261, P<0.001). Stepwise multiple regression analysis showed that high BMI (β=0.146; P=0.001) and SMI (β=0.228, P<0.001), young age (β=–0.091, P=0.025), and a low FRLV/TLV ratio (β=–0.225, P<0.001) were predictors of greater remnant liver regeneration.
Conclusions
High SMI and BMI, young age, and a low FRLV/TLV ratio may predict greater early remnant liver regeneration in living donors after LDLT.

Keyword

Liver transplantation; Living donors; Computed tomography volumetry; Liver regeneration; Skeletal muscle index

Figure

• 

  Fig. 1 Relationships between remnant liver regeneration volume on postoperative day (POD) 7 and preoperative variables, including age (A), body mass index (BMI; B), future remnant liver volume to total liver volume (FRLV/TLV) ratio (C), and skeletal muscle index (SMI; D) in living liver donors after right hemihepatectomy.

Reference

1. European Association for the Study of the Liver. 2016; EASL clinical practice guidelines: liver transplantation. J Hepatol. 64:433–85. DOI: 10.1016/j.jhep.2015.10.006. PMID: 26597456.

2. Lee SG. 2015; A complete treatment of adult living donor liver transplantation: a review of surgical technique and current challenges to expand indication of patients. Am J Transplant. 15:17–38. DOI: 10.1111/ajt.12907. PMID: 25358749.

3. Yagi S, Hirata M, Miyachi Y, Uemoto S. 2020; Liver regeneration after hepatectomy and partial liver transplantation. Int J Mol Sci. 21:8414. DOI: 10.3390/ijms21218414. PMID: 33182515. PMCID: PMC7665117.

4. Olthoff KM, Emond JC, Shearon TH, Everson G, Baker TB, Fisher RA, et al. 2015; Liver regeneration after living donor transplantation: adult-to-adult living donor liver transplantation cohort study. Liver Transpl. 21:79–88. DOI: 10.1002/lt.23966. PMID: 25065488. PMCID: PMC4276514.

5. Haga J, Shimazu M, Wakabayashi G, Tanabe M, Kawachi S, Fuchimoto Y, et al. 2008; Liver regeneration in donors and adult recipients after living donor liver transplantation. Liver Transpl. 14:1718–24. DOI: 10.1002/lt.21622. PMID: 19025926.

6. Zappa M, Dondero F, Sibert A, Vullierme MP, Belghiti J, Vilgrain V. 2009; Liver regeneration at day 7 after right hepatectomy: global and segmental volumetric analysis by using CT. Radiology. 252:426–32. DOI: 10.1148/radiol.2522080922. PMID: 19703882.

7. Tanemura A, Mizuno S, Wada H, Yamada T, Nobori T, Isaji S. 2012; Donor age affects liver regeneration during early period in the graft liver and late period in the remnant liver after living donor liver transplantation. World J Surg. 36:1102–11. DOI: 10.1007/s00268-012-1496-1. PMID: 22374540.

8. Gruttadauria S, Parikh V, Pagano D, Tuzzolino F, Cintorino D, Miraglia R, et al. 2012; Early regeneration of the remnant liver volume after right hepatectomy for living donation: a multiple regression analysis. Liver Transpl. 18:907–13. DOI: 10.1002/lt.23450. PMID: 22505370.

9. Carey EJ, Lai JC, Sonnenday C, Tapper EB, Tandon P, Duarte-Rojo A, et al. 2019; A North American expert opinion statement on sarcopenia in liver transplantation. Hepatology. 70:1816–29. DOI: 10.1002/hep.30828. PMID: 31220351. PMCID: PMC6819202.

10. Pravisani R, Soyama A, Ono S, Baccarani U, Isola M, Takatsuki M, et al. 2020; Is there any correlation between liver graft regeneration and recipient's pretransplant skeletal muscle mass? A study in extended left lobe graft living-donor liver transplantation. Hepatobiliary Surg Nutr. 9:183–94. DOI: 10.21037/hbsn.2019.11.08. PMID: 32355676. PMCID: PMC7188548.

11. Lee J, Kim N, Lee H, Seo JB, Won HJ, Shin YM, et al. 2007; Efficient liver segmentation using a level-set method with optimal detection of the initial liver boundary from level-set speed images. Comput Methods Programs Biomed. 88:26–38. DOI: 10.1016/j.cmpb.2007.07.005. PMID: 17719125.

12. Malladi R, Sethian JA, Vemuri BC. 1995; Shape modeling with front propagation: a level set approach. IEEE Trans Pattern Anal Mach Intell. 17:158–75. DOI: 10.1109/34.368173.

13. Park HJ, Shin Y, Park J, Kim H, Lee IS, Seo DW, et al. 2020; Development and validation of a deep learning system for segmentation of abdominal muscle and fat on computed tomography. Korean J Radiol. 21:88–100. DOI: 10.3348/kjr.2019.0470. PMID: 31920032. PMCID: PMC6960305.

14. Ikegami T, Nishizaki T, Yanaga K, Shimada M, Kishikawa K, Nomoto K, et al. 2000; The impact of donor age on living donor liver transplantation. Transplantation. 70:1703–7. DOI: 10.1097/00007890-200012270-00007. PMID: 11152100.

15. Kwon KH, Kim YW, Kim SI, Kim KS, Lee WJ, Choi JS. 2003; Postoperative liver regeneration and complication in live liver donor after partial hepatectomy for living donor liver transplantation. Yonsei Med J. 44:1069–77. DOI: 10.3349/ymj.2003.44.6.1069. PMID: 14703618.

16. Kim SJ, Kim DG, Chung ES, Lee YJ, Moon IS, Lee MD. 2006; Adult living donor liver transplantation using the right lobe. Transplant Proc. 38:2117–20. DOI: 10.1016/j.transproceed.2006.06.003. PMID: 16980017.

17. Ono Y, Kawachi S, Hayashida T, Wakui M, Tanabe M, Itano O, et al. 2011; The influence of donor age on liver regeneration and hepatic progenitor cell populations. Surgery. 150:154–61. DOI: 10.1016/j.surg.2011.05.004. PMID: 21719061.

18. Nakagami M, Morimoto T, Itoh K, Arima Y, Yamamoto Y, Ikai I, et al. 1998; Patterns of restoration of remnant liver volume after graft harvesting in donors for living related liver transplantation. Transplant Proc. 30:195–9. DOI: 10.1016/S0041-1345(97)01229-3. PMID: 9474999.

19. Miyachi Y, Kaido T, Hirata M, Iwamura S, Yao S, Shirai H, et al. 2020; The combination of a male donor's high muscle mass and quality is an independent protective factor for graft loss after living donor liver transplantation. Am J Transplant. 20:3401–12. DOI: 10.1111/ajt.15884. PMID: 32243072.

20. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. 2019; Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 48:16–31. DOI: 10.1093/ageing/afy169. PMID: 30312372. PMCID: PMC6322506.