TOTAL HEPATECTOMY AND LIVER-TRANSPLANTATION AS 2-STAGE PROCEDURE

Objective This article describes the experience with a bridging proced ure for a prolonged anhepatic period during clinical liver transplanta tion in case of special emergency situations. Summary Background Data Hepatic necrosis due to fulminant hepatitis or acute graft failure, as well as severe liver trauma are well-known and accepted indications f or urgent liver transplantation. Prerequisite is the allocation of a s uitable donor organ. If no allograft is available in time, patients wi th ''toxic liver syndrome'' or exsanguinating hemorrhage have been sho wn to benefit from advanced total hepatectomy. Methods As a modificati on of the standard one-stage procedure, recipient hepatectomy and subs equent liver transplantation are performed in two separate operations. To bridge the prolonged anhepatic period and to allow decompression a nd return of venous blood, an end-to-side portocaval shunt is construc ted temporarily. Results Thirteen of thirty-two patients underwent hep atectomy but not transplantation subsequently, and died within 34 hour s after progressive deterioration. In 19 of 32 patients, transplantati on was realized 6-41 hours after hepatectomy; 9 of 19 patients died, m ostly from sepsis. Ten of nineteen liver recipients survived the proce dure including three unrelated late deaths; presently, seven patients are alive with a follow-up of 3 to 46 months. Conclusions Two-stage to tal hepatectomy with temporary portocaval shunt, and subsequent liver transplantation can be a life-saving approach in patients most likely to die of the sequelae of advanced liver or graft necrosis or exsangui nation that cannot be controlled by conventional treatment or immediat e liver transplantation.