Auxiliary partial orthotopic versus standard orthotopic whole liver transplantation for acute liver failure - A reappraisal from a single center by acase-control study

Citation
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
Citations number
38
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
ANNALS OF SURGERY
ISSN journal
00034932 → ACNP
Volume
234
Issue
6
Year of publication
2001
Pages
723 - 731
Database
ISI
SICI code
0003-4932(200112)234:6<723:APOVSO>2.0.ZU;2-6
Abstract
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.