LONG-TERM FOLLOW-UP OF AUXILIARY ORTHOTOPIC LIVER-TRANSPLANTATION FORTHE TREATMENT OF FULMINANT HEPATIC-FAILURE

Background. Auxiliary orthotopic liver transplantation (AOLT) was inve stigated as a bridge to native liver recovery in patients with fulmina nt hepatic failure (FHF). Methods. In the last 5 years seven patients with FHF were treated with AOLT at our institution. Five patients unde rwent resection of the native left lobe and orthotopic replacement wit h a donor left lobe (n = 3) or left lateral segment (n = 2). Two patie nts underwent left trisegmentectomy and whole liver auxiliary grafting . Conventional immunosuppression was used in all patients. Results. On e patient had poor initial graft function and required retransplantati on. Native liver function returned to normal in the six other patients . Immunosuppression was gradually tapered and completely discontinued in three patients, allowing for atrophy of the allograft. The allograf t was removed in the other four patients. Despite evidence of native l iver regeneration, two patients with aplastic anemia died after allogr aft removal. Four patients are alive at a mean follow-up of 3.5 years. Conclusions. AOLT is technically feasible, rapidly restores liver fun ction, and should be considered an important alternative to standard o rthotopic liver transplantation (OLT) in the treatment of FHF. AOLT ha s the advantage that patients transplanted for FHF are not committed t o lifelong immunosuppression with its attendant risks.