Objectives This study investigated whether liver regeneration after living donor liver transplantation (LDLT) is associated with baseline skeletal muscle status, based on preoperative computed tomography (CT). Materials and methods In this retrospective cohort study, skeletal muscle mass and skeletal muscle attenuation (SMA) from preoperative CT scans of living liver donors who underwent right hemihepatectomy were analyzed. The liver regeneration rate was calculated as the percentage of remnant liver volume on postoperative CT performed 45–90 days after surgery, divided by the estimated preoperative left hemiliver volume. Logistic regression analysis identified risk factors for suboptimal regeneration, defined as the lower 10th percentile of liver regeneration rate. Correlation between skeletal muscle metrics and liver regeneration rate was assessed using Spearman’s correlation analysis. Results A total of 171 living liver donors (101 men, 70 women; median age, 34 years) were included. Lower SMA, measured on contrast-enhanced CT images acquired in the portal venous phase, was significantly and independently associated with an increased risk of suboptimal regeneration (adjusted odds ratio: 1.14 per 1 Hounsfield unit decrease; 95% confidence interval: 1.04–1.25). SMA showed a significant positive correlation with liver regeneration rate (ρ = 0.191, p = 0.013). Conclusions Lower SMA, as assessed on preoperative CT, is associated with suboptimal liver regeneration following right hemihepatectomy for living donor liver transplantation. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Adequate liver regeneration is crucial after living donor liver transplantation, but reliable donor-related prognostic factors to predict it remain limited. <Emphasis Type="BoldItalic">Findings</Emphasis> Lower skeletal muscle attenuation on portal venous phase CT acquired 45–90 days after right hemihepatectomy was independently associated with suboptimal liver regeneration among living liver donors. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Preoperative skeletal muscle attenuation may help identify living liver donors at risk for suboptimal liver regeneration, offering a potential tool for donor selection and personalized assessment to ensure adequate postoperative liver volume and long-term hepatic reserve in clinical practice. Graphical Abstract

Preoperative skeletal muscle assessment as a predictor of liver regeneration in living donor liver transplantation

期刊论文
发表日期：

2026年3月12日

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Ji Hyun Lee,
Woo Kyoung Jeong,
Jong Man Kim,
Gyu-Seong Choi,
Jinsoo Rhu,
Dong Ik Cha

摘要

Objectives

This study investigated whether liver regeneration after living donor liver transplantation (LDLT) is associated with baseline skeletal muscle status, based on preoperative computed tomography (CT).

Materials and methods

In this retrospective cohort study, skeletal muscle mass and skeletal muscle attenuation (SMA) from preoperative CT scans of living liver donors who underwent right hemihepatectomy were analyzed. The liver regeneration rate was calculated as the percentage of remnant liver volume on postoperative CT performed 45–90 days after surgery, divided by the estimated preoperative left hemiliver volume. Logistic regression analysis identified risk factors for suboptimal regeneration, defined as the lower 10^th percentile of liver regeneration rate. Correlation between skeletal muscle metrics and liver regeneration rate was assessed using Spearman’s correlation analysis.

Results

A total of 171 living liver donors (101 men, 70 women; median age, 34 years) were included. Lower SMA, measured on contrast-enhanced CT images acquired in the portal venous phase, was significantly and independently associated with an increased risk of suboptimal regeneration (adjusted odds ratio: 1.14 per 1 Hounsfield unit decrease; 95% confidence interval: 1.04–1.25). SMA showed a significant positive correlation with liver regeneration rate (ρ = 0.191, p = 0.013).

Conclusions

Lower SMA, as assessed on preoperative CT, is associated with suboptimal liver regeneration following right hemihepatectomy for living donor liver transplantation.

Key Points

Question Adequate liver regeneration is crucial after living donor liver transplantation, but reliable donor-related prognostic factors to predict it remain limited.

Findings Lower skeletal muscle attenuation on portal venous phase CT acquired 45–90 days after right hemihepatectomy was independently associated with suboptimal liver regeneration among living liver donors.

Clinical relevance Preoperative skeletal muscle attenuation may help identify living liver donors at risk for suboptimal liver regeneration, offering a potential tool for donor selection and personalized assessment to ensure adequate postoperative liver volume and long-term hepatic reserve in clinical practice.

Graphical Abstract