Korean J Transplant.  2023 Nov;37(Suppl 1):S34. 10.4285/ATW2023.F-6035.

The impact of age on liver regeneration after living donor right hemihepatectomy in elderly donors

• Kim NR
• Han DH

• KMID: 2551621
• DOI: http://doi.org/10.4285/ATW2023.F-6035

Abstract

Background
The expanding donor pool includes marginal donors with steatosis, small-for-size grafts, and elderly donors. This study aimed to investigate liver volumetric regeneration after living donor right hepatectomy (LDRH) in elderly and younger donors, focusing on age impact.
Methods
From March 2012 to December 2022, 38 elderly donors (≥55 years) and 291 younger donors (<30 years) underwent LDRH. Donors without preoperative liver fibroscan or postoperative follow-up computed tomography (CT) scans after 3 months were excluded. Propensity score matching resulted in a final cohort of 55 younger and 30 elderly donors. Remnant liver volume was assessed via CT scans within 1 year after surgery. Comparative analysis conducted on pre- and postoperative clinical characteristics, as well as liver volumetric regeneration over time between the two groups. Additionally, binary logistic regression was used to analyze risk factors for poor liver regeneration.
Results
The mean age was 58.0 and 24.0 years for elderly and younger donor, respectively. Preoperative factors were similar between two groups. Rapid liver regeneration occurred within the first months (median 465.9 mL, 77.8% of initial total liver vol-ume [iTLV]), but elderly donors showed significantly lower liver regeneration rates than younger age donors throughout all time points (around 1 month: 83.5 vs. 75.5%, P=0.001; 3 months: 89.9 vs. 79.2%, P<0.001; 6 months: 94.7 vs. 86.2%, P=0.001, all com-pared to iTLV). Multivariate logistic regression analysis identified old age and low preoperative phosphate level (<3.5 mg/dL) as risk factors for liver regeneration below 80% of iTLV.
Conclusions
After LDRH, liver regeneration within 1 year reaches over 95% of the original volume in young donors but is less, at approximately 86% of the original volume, in elderly donors. Therefore, more conservative criteria for the remnant liver volume need in elderly donors compared to younger donors.