Auxiliary partial orthotopic liver transplantation for acute liver failure

• Published in: Journal of hepatology 1997-05, Vol.26 (5), p.1010-1017
• Main Authors: Pereira, Stephen P., McCarthy, Michelle, Ellis, Antony J., Wendon, Julia, Portmann, Bernard, Rela, Mohammed, Heaton, Nigel, Williams, Roger
• Format: Article
• Language: English
• Subjects: Acute Disease; Acute liver failure; Adolescent; Adult; Auxiliary partial; Biliary Tract - diagnostic imaging; Biological and medical sciences; Female; Humans; Immunosuppression; Liver - diagnostic imaging; Liver - pathology; Liver Failure - pathology; Liver Failure - surgery; Liver Regeneration; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Orthotopic liver transplantation; Radionuclide Imaging; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/S0168-8278(97)80109-2

Background/Aims: Auxiliary partial orthotopic liver transplantation holds potential advantages over conventional orthotopic liver transplantation, but experience with the technique in acute liver failure is limited. Methods: We describe our initial experience in seven patients (4 men, 3 women; mean age 28, range 14–35 years) with acute liver failure (paracetamol 3, non A-E 2, autoimmune 1, Ecstasy 1) who fulfilled criteria for emergency transplantation. Preoperatively, the median international normalised ratio was seven (range 3.4–15), with a creatinine of 123 μM (51–389 μM) and bilirubin 320 μM (61–572 μM). The reasons for performing an auxiliary transplant were the patients' young age and stable preoperative condition ( n=5), or a significant psychiatric history precluding conventional transplantation ( n=2). Results: All patients received blood group-matched left ( n=2) or right ( n=5) auxiliary grafts. Median duration of surgery was 8.5 h (7.3–10 h), with blood loss of 8.3 litres (4.6–14.6 litres). Post-transplant, the international normalised ratio and aspartate amino-transferase fell progressively in all patients, with median values at day 7 of 1.4 (1.0–2.4) and 108 IU/l (78–910 IU/l). Three patients died from sepsis within the first postoperative month. At 2 weeks, four of six patients had partial regeneration of the native liver, which became complete in two of the survivors by 1 year. Conclusions: Although patient selection remains poorly defined, auxiliary partial orthotopic liver transplantation in acute liver failure is technically feasible and, in some patients, allows native liver regeneration and eventual immunosuppression withdrawal.