Assessment of liver regeneration in living donor liver transplantation recipients using computed tomography volumetry-an institutional experience.

Abstract

Backgrounds/aims: Early liver graft regeneration after living donor liver transplantation (LDLT) is critical for patient outcomes, yet prospective volumetric data from Indian recipients remain limited. This study quantifies early graft regeneration and identifies predictors using computed tomography (CT) volumetry.

Methods: In this prospective single-center study, 34 consecutive adult LDLT recipients underwent CT volumetry on postoperative days 7 and 30.

Results: Mean baseline graft volume was 607.9 ± 137.9 cm³, increasing to 957.3 ± 175.7 cm³ at day 7 (+62%, p < 0.001) and 1,293.4 ± 247.0 cm³ at day 30 (+111%, p < 0.001), achieving 93% ± 22.7% of predicted standard liver volume (SLV). Multivariate analysis identified recipient body mass index (BMI) (β = 29.4 cm³/kg/m², 95% CI 14.4-44.4, p < 0.001) and graft-to-recipient-weight ratio (GRWR) (β = 435.9 cm³ per unit, 95% CI 95-777, p = 0.015) as independent predictors of day-30 graft volume (adjusted R² = 0.349). Left-lobe grafts showed higher proportional growth than right-lobe grafts (174% ± 41% vs. 103% ± 34%, p < 0.001) with comparable absolute volumes (p = 0.56). Younger recipients (19-41 years) demonstrated greater regeneration than older recipients (56-64 years; 160% ± 32% vs. 109% ± 38%, p = 0.01). Mild macrosteatosis (< 30%) did not impair regeneration.

Conclusions: Liver graft regeneration in this Indian LDLT cohort was rapid, with near-complete SLV restoration by 30 days. BMI and GRWR independently predicted volumetric recovery, supporting personalized graft selection and the expanded use of left-lobe grafts.