Auxiliary Partial Orthotopic Liver Transplantation for Acute Liver Failure: Not Supportive Enough?

Auxiliary partial orthotopic liver transplantation (APOLT) entails the removal of part of the native liver and replacement with the corresponding part of donor liver. APOLT is usually performed for acute liver failure and metabolic liver disease. However, many technical concerns limit its acceptance...

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Bibliographic Details
Published in:Indian journal of surgery 2022-08, Vol.84 (Suppl 2), p.424-430
Main Authors: Binoj, S. T., Mathew, Johns Shaji, Razak, M. Abdul, Nair, Krishnanunni, Mallick, Shweta, Varghese, Christi Titus, Chandran, Biju, Menon, Ramachandran Narayana, Balakrishnan, Dinesh, Gopalakrishnan, Unnikrishnan, Devi, Padma Uma, Sudheer, O. V., Surendran, Sudhindran
Format: Article
Language:English
Subjects:
Cardiac Surgery
Development and progression
Drug overdose
Hepatitis
Hepatitis A
Immunosuppressive agents
Liver
Liver failure
Liver transplants
Medicine
Medicine & Public Health
Neurosurgery
Original Article
Pediatric Surgery
Plastic Surgery
Surgery
Thoracic Surgery
Transplantation
Transplants & implants
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Summary:Auxiliary partial orthotopic liver transplantation (APOLT) entails the removal of part of the native liver and replacement with the corresponding part of donor liver. APOLT is usually performed for acute liver failure and metabolic liver disease. However, many technical concerns limit its acceptance globally. In this study, we describe our experience of 6 APOLT performed for acute liver failure. Out of the 68 liver transplants performed in our center for acute liver failure, six were APOLT. APOLT was performed in the setting of hyperacute liver failure with no other organ failure. The recovery of the native liver was assessed using hepatobiliary scintigraphy every six months. Immunosuppressant withdrawal was attempted once 50% recovery of the native liver was attained in the scan. All donors were first-degree relatives. Etiology was hepatitis A in 4 patients, yellow phosphorous poisoning in 1, and cryptogenic fulminant hepatic failure in the remaining 1 patient. Five of them were blood group identical and one was ABO incompatible (AB to A). Post-operatively, three patients died, two due to massive cerebral edema, and one due to sepsis. All the survivors at a follow-up period of 2 years are off immunosuppressants and are doing well. Auxiliary liver transplant in acute liver failure has a poor success rate. However, the technique can be considered in a very selected group of patients with hepatitis A-related hyperacute liver failure.
ISSN:0972-2068
0973-9793
DOI:10.1007/s12262-021-02925-9