AUXILIARY LIVER-TRANSPLANTATION FOR FULMINANT AND SUBFULMINANT HEPATIC-FAILURE

We report the first series of 9 auxiliary liver transplantations perfo rmed as a bridge to recovery in 8 patients with fulminant and subfulmi nant hepatic failure, Hepatic failure was due to hepatitis A virus (n = 3), hepatitis B virus (n = 1), hepatotoxic drugs (n = 2), autoimmune disease (n = 1), or it was of unknown origin (n = 1), The donor liver was reduced to a left lobe (n = 2), a left liver (n = 4), or a right liver (n = 3), and was implanted in an orthotopic position beside the native liver after it was resected by a left or a right hepatectomy, C onventional immunosuppression was used to prevent rejection. Six patie nts regained normal consciousness within 2 weeks, without any sequelae . Two patients had persisting encephalopathy due to graft initial dysf unction, one of whom showed portal vein thrombosis, which was successf ully cleared, The other one showed hepatic vein stenosis and was retra nsplanted at day 15, Five of eight patients had to be reoperated becau se of a surgical complication. Five patients showed rapid regeneration of their native liver, but one died at day 45 from severe herpes viru s broncholitis. The auxiliary grafts were removed (n = 3) or left to a trophy by tapering immunosuppression (n = 1), One patient developed ci rrhosis of the native liver and died of infectious complications at da y 42. The native livers of the two remaining patients are still atroph ic, one at 4 months and one at 1 month posttransplant, Finally, 6 of 8 patients are alive with a follow-up of 1 to 17 months. Four of them h ave permanently stopped their immunosuppressive therapy. Our experienc e demonstrates that auxiliary orthotopic liver transplantation (1) is feasible in children and adults, using either a left or a right liver graft, (2) is efficient in providing adequate liver function, and (3) gives a real chance to the native liver to regenerate, offering these patients a future free of immunosuppression.