Auxiliary partial orthotopic versus standard orthotopic whole liver transplantation for acute liver failure - A reappraisal from a single center by acase-control study
D. Azoulay et al., Auxiliary partial orthotopic versus standard orthotopic whole liver transplantation for acute liver failure - A reappraisal from a single center by acase-control study, ANN SURG, 234(6), 2001, pp. 723-731
Objective To reappraise the results of auxiliary partial orthotopic liver t
ransplantation (APOLT) compared with those of standard whole-liver transpla
ntation (OLT) in terms of postoperative death and complications, including
neurologic sequelae.
Summary Background Data Compared with OLT, APOLT preserves the possibility
for the native liver to recover, and to stop immunosuppression.
Methods In a consecutive series of 49 patients transplanted for fulminant o
r subfulminant hepatitis, 37 received OLT and 12 received APOLT. APOLT was
done when logistics allowed simultaneous performance of graft preparation a
nd the native liver partial hepatectomy to revascularize the graft as soon
as possible. Each patient undergoing APOLT (12 patients) was matched to two
patients undergoing OLT (24 patients) according to age, grade of coma, eti
ology, and fulminant or subfulminant type of hepatitis. All grafts in the s
tudy population were retrieved from optimal donors.
Results Before surgery, both groups were comparable in all aspects. In-hosp
ital death occurred in 4 of 12 patients undergoing APOLT compared with 6 of
24 patients undergoing OLT. Patients receiving APOLT had 1 +/- 1.3 technic
al complications compared with 0.3 +/- 0.5 for OLT patients. Bacteriemia wa
s significantly more frequent after APOLT than after OLT. The need for retr
ansplantation was significantly higher in the APOLT patients (3/12 vs. 0/24
). Brain death from brain edema or neurologic sequelae was significantly mo
re frequent after APOLT (4/12 vs. 2/24). One-year patient survival was comp
arable in both groups (66% vs. 66%), and there was a trend toward lower 1-y
ear retransplantation-free survival rates in the APOLT group (39% vs. 66%).
Only 2 of 12 (17%) patients had full success with APOLT (i.e., patient sur
vival, liver regeneration, withdrawal of immunosuppression, and graft remov
al). One of these two patients had neurologic sequelae.
Conclusions Using optimal grafts, APOLT and OLT have similar patient surviv
al rates. However, the complication rate is higher with APOLT. On an intent
-to-treat basis, the efficacy of the APOLT procedure is low. This analysis
suggests that the indications for an APOLT procedure should be reconsidered
in the light of the risks of technical complications and neurologic sequel
ae.