Increased Liver Stiffness Despite Biochemical Recovery in Living Donors 1-Year Post-Hepatectomy

Living donor hepatectomy is widely regarded as safe based on short-term outcomes and biochemical recovery; however, the long-term structural adaptation of the regenerated liver remains poorly understood. We evaluated longitudinal changes in liver stiffness and steatosis using transient elastography in living liver donors.

We retrospectively analysed prospectively collected data from 152 donors who underwent pure laparoscopic right or extended right hepatectomy and completed FibroScan assessments before donation and at 12 months postoperatively.

At 1 year, liver stiffness increased in 90.1% of donors, with 21.1% exceeding the upper limit of normal (≥ 6.9 kPa) despite normal liver function tests. Older age and higher preoperative body mass index were independently associated with elevated postoperative liver stiffness, while steatosis showed modest changes and weak correlation with stiffness alterations. Although diabetes was rare, all four donors with diabetes showed elevated postoperative liver stiffness.

These findings suggest that biochemical recovery and volumetric regeneration alone may not fully reflect the structural integrity of the regenerated liver, as inferred from liver stiffness changes. Given the association between increased postoperative liver stiffness and metabolic risk factors, reliance on short-term functional monitoring alone may be insufficient, particularly among donors with metabolic risk factors. This underscores the potential value of long-term non-invasive surveillance and a more individualised approach to donor follow-up, while further studies are needed to validate the histological and prognostic significance of these findings.