Donor-Specific Digital Twin for Living Donor Liver Transplant Recovery

Abstract

Liver resection initiates a meticulously coordinated hyperplasia process characterized by regulated cell proliferation that drives liver regeneration. This process concludes with the complete restoration of liver mass, showcasing the precision and robustness of this homeostasis. The remarkable capacity of the liver to regenerate rapidly into a fully functional organ has been crucial to the success of living donor liver transplantation (LDLT). In healthy livers, hepatocytes typically remain in a quiescent state (G0). However, following partial hepatectomy, these cells transition to the G1 phase to re-enter the cell cycle. Surgical resection induces various stresses, including physical injury, altered blood flow, and increased metabolic demands. These all trigger the activation and suppression of numerous genes involved in tissue repair, regeneration, and functional recovery. Both coding and noncoding RNAs detectable in the bloodstream during this process provide valuable insights into the gene responses driving liver recovery. This study integrates clinical gene expression data into a previously developed mathematical model of liver regeneration, which tracks transitions among quiescent, primed, and proliferating hepatocytes to construct virtual, patient-specific liver models. Using whole transcriptome RNA sequencing data from 12 healthy LDLT donors, collected at 14 time points over a year, we identified liver resection-specific gene expression patterns through Weighted Gene Co-expression Network Analysis (WGCNA). These patterns were organized into distinct clusters with unique transcriptional dynamics and mapped to model variables using deep learning techniques. Consequently, we developed a Personalized Progressive Mechanistic Digital Twin (PePMDT) for the livers of LDLT donors. The resulting PePMDT predicts individual patient recovery trajectories by leveraging blood-derived gene expression data to simulate regenerative responses. By transforming gene expression profiles into dynamic model variables, this approach bridges clinical data and mathematical modeling, providing a robust platform for personalized medicine. This study highlights the transformative potential of data-driven frameworks like PePMDT in advancing precision medicine and optimizing recovery outcomes for LDLT donors.