Serum lipid expression correlates with function and regeneration following living donor liver transplantation

Abstract

Following living donor liver transplantation (LDLT; and unlike deceased donor liver transplantation [DDLT]), the liver must rapidly regenerate, and sometimes segmental graft dysfunction (SGD) is observed. Hepatic regeneration requires substantial de novo lipid synthesis, and we previously reported that expression of lipid-related genes is dysregulated in LDLT. Here, we compare serum lipid measurements in 41 LDLT recipients and 43 DDLT recipients at baseline and at serial posttransplant time points. In addition, we examined whether serum lipid/apolipoprotein (apo) levels correlate with the degree of liver regeneration (measured using percent volume increase [%VI] at 3 months) or SGD in LDLT recipients. In contrast to DDLT, lipid levels declined early after LDLT but returned to baseline by 30 days. The odds ratio (OR) for achieving robust regeneration (>90 %VI) was 2.53 (95% confidence interval [CI], 1.15-5.52) for every 1 mg/dL increase in serum apoE at 30 days. The OR of SGD for every year increase in donor age was 1.19 (95% CI, 1.02-1.39), and 0.61 for every 1 mg/dL increase in serum high-density lipoprotein cholesterol at 7 days (95% CI, 0.34-1.11). No associations were detected between preoperative serum lipids/apos in LDLT donors and SGD or %VI in recipients. In conclusion, we suggest that initiation of regeneration prevents the liver from participating fully in lipid transport and metabolism. Inability to meet systemic metabolic needs may result in compromised liver function and SGD. Certain serum lipid concentrations correlate with extent of liver regeneration and function.

Trial registration: ClinicalTrials.gov NCT00096733.

© 2015 American Association for the Study of Liver Diseases.

Figures

Figure 1. Absolute serum lipid levels for DDLT and LDLT recipients

Serum lipid levels are shown as Tukey plots for each of the 5 measured timepoints in DDLT and LDLT recipients. Significant differences between the groups are noted with an asterisk; however, for visual simplification we have not included notation for significant differences within each group (example: LDLT day 0 vs. LDLT day 1). Abbreviations: cLDL = calculated low density lipoprotein.

Figure 2. Relative lipid levels for DDLT and LDLT recipients

Serum lipid levels are shown relative to post-transplant day 1 using Tukey plots for each of the 5 measured timepoints in DDLT and LDLT recipients. Significant differences between the groups are noted with an asterisk; however, for visual simplification we have not included notation for significant differences within each group (example: LDLT day 0 vs. LDLT day 1). Abbreviations: cLDL = calculated low density lipoprotein.

Figure 3. Differences in serum lipid levels for recipients with SGD

Day 7 and day 14 levels of apoA-I and HDL were significantly lower in patients with SGD. Data are displayed with Tukey plots and comparisons were performed with Wilcoxon ranksum.