Auxiary Liver Transplantation For Fulminant And Subfulminant Hepatic Failure

Boudjéma, Karim; Cherqui, Daniel; Jaeck, Daniel; Mp, Chenard-Neu; Steib, A.; Freis, G.; Becmeur, F.; Brunot, B.; Siméoni, Umberto; Jp, Bellocq

doi:10.1097/00007890-199501000-00011

Cited by 110 publications

(44 citation statements)

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“…Functional competition between the NL and the auxiliary graft has been emphasized in several clinical studies [2, 4,5,16,20,21]. These studies mainly focus on the influence of underlying liver disease and graft rejection [2, 4, 51.…”

Section: Discussionmentioning

confidence: 99%

“…In clinical ALT, the graft can be reduced to a right liver (approximately 65 YO of the whole liver volume), a left liver (35 YO) or a left lobe (20%) [2,4,12]. In ALT for FHF, the necessity of quick restoration of liver function and reversal of cerebral oedema argues for the use of the right liver [2,4, 141.…”

Section: Discussionmentioning

confidence: 99%

“…Once complete regeneration of the NL has taken place, immunosuppression is stopped and the graft can be removed [4]. A recent European study comprising 30 patients has shown that this aim can be achieved in up to 68% of patients undergoing ALT for FHF [5].…”

Section: Introductionmentioning

confidence: 99%

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Auxiliary liver transplantation: how to improve regeneration of the native liver by surgery

Sauvanet¹,

Song²,

Bernuau³

et al. 1999

Transplant International

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The technical factors which could influence regeneration of the native liver (NL) in auxiliary liver transplantation (ALT) for fulminant hepatic failure (FHF) are not well known. We studied NL regeneration according to the location of graft anastomosis in the recipient's portal system (superior mesenteric vein versus portal vein), and graft weight (50 ' 740 reduced-size versus full-size graft) in a rat model of ALT with 80 % reduction of the NL, and graft arterialization. NL regeneration was significantly more obvious when the graft was anastornosed on the recipient's superior mesenteric vein, thus establishing venous flow to the NL from the pancreas, the spleen, and the stomach, and when a full-size graft was used. The influence of portal venous flow on NL regeneration, assessed by [3H]-thymidine incorporation, was measurable as early as day 2. Both technical variables in combination resulted in significantly greater regeneration (ratio weight of NL/body weight at day 30: 2.32 * 0.68 % versus 1.21 f. 0.63 % respectively, P = 0.02). Early preservation of portal flow to the NL is advisable to maximize NL regeneration in ALT. In any case, this regeneration is not impeded by the use of large auxiliary grafts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Auxiliary liver transplantation: how to improve regeneration of the native liver by surgery

Sauvanet¹,

Song²,

Bernuau³

et al. 1999

Transplant International

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“…After native hepatic function is demonstrated, the auxiliary graft can b e r e m o v e d , b u t i s m o s t f r e q u e n t l y a l l o w e d t o a t r o p h y b y w i t h d r a w a l o f immunosuppression. Complete cessation of immunosuppression can be achieved in many patients (Boudjema et al, 1995).…”

Section: Auxiliary Liver Transplantationmentioning

confidence: 99%

Intensive Care Management of Patients Prior to Liver Transplantation

Subramanian¹

2012

Liver Transplantation - Basic Issues

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“…2 Auxiliary partial orthotopic liver transplantation (APOLT) has been the more commonly used technique. [3][4][5][6][7] However, this procedure is technically more difficult than orthotopic liver transplantation (OLT) because recipient hemihepatectomy is required for implantation of the partial liver graft. Auxiliary heterotopic liver transplantation (AHLT) with portal vein arterialization (PVA) has several advantages over APOLT: NL resection is not required, and the hepatic hilum is left untouched; therefore, the chances of liver regeneration are optimal.…”

mentioning

confidence: 99%

Auxiliary heterotopic liver transplantation with portal vein arterialization for fulminant hepatic failure

et al. 2000

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Auxiliary liver transplantation for patients with fulminant hepatic failure supports the patient's failing liver for a period of time until the native liver (NL) has recovered and immunosuppression can be withdrawn. Auxiliary heterotopic liver transplantation (AHLT) with portal vein arterialization (PVA) has several advantages over auxiliary orthotopic liver transplantation: NL resection is not required, and the hepatic hilum is left untouched; thus, the chances of liver regeneration are optimal. The successful application of emergency AHLT with PVA in a young patient who developed toxic fulminant hepatic failure caused by tuberculostatic drugs is described. Two and one-half months after the procedure, the NL had completely regenerated; the graft was removed, and immunosuppression was suspended. (Liver Transpl 2000;6: 805-809.)A uxiliary liver transplantation (ALT) for patients with fulminant hepatic failure supports the patient's failing liver for a period of time until the native liver (NL) has recovered. 1 A multicenter European study showed that in two thirds of the patients, liver regeneration occurred and immunosuppression could be withdrawn. 2 Auxiliary partial orthotopic liver transplantation (APOLT) has been the more commonly used technique. [3][4][5][6][7] However, this procedure is technically more difficult than orthotopic liver transplantation (OLT) because recipient hemihepatectomy is required for implantation of the partial liver graft. Auxiliary heterotopic liver transplantation (AHLT) with portal vein arterialization (PVA) has several advantages over APOLT: NL resection is not required, and the hepatic hilum is left untouched; therefore, the chances of liver regeneration are optimal. 8,9 We describe the successful application of emergency AHLT with PVA in a young patient who developed toxic fulminant hepatic failure caused by tuberculostatic drugs. Case ReportA 25-year-old black man, an illegal immigrant from an African country, was admitted to our unit with acute liver failure from toxic hepatitis. The patient had been diagnosed with tuberculous pleural effusion and treated with rifampin, 600 mg/d; isoniazid, 250 mg/d; and pyrazinamide, 1,500 mg/d. Twenty days later, he presented with a high fever, headache, vomiting, arthromyalgia, and confusion. Laboratory blood tests showed the following values: aspartate aminotransferase (AST), 11,505 U/L; amylase, 493 U/L; lipase, 3.451 U/L; creatine kinase, 1,286 U/L; international normalized ratio, 2.32; blood urea nitrogen (BUN), 46 mg/dL; and creatinine, 1.6 mg/dL. Cerebrospinal fluid and cranial computed tomography results were normal. A diagnosis of fulminant hepatic failure caused by hepatotoxic antituberculous medications was made, and the patient was referred to our unit.On admission, the patient presented with grade I encephalopathy. Blood analyses showed the following values: bilirubin, 1.6 mg/dL; AST, 7,570 U/L; prothrombin time, 30%; creatinine, 1.6 mg/dL; and negative serologic test results for viral hepatitis A, B, and C. Over the following ...

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Auxiary Liver Transplantation For Fulminant And Subfulminant Hepatic Failure

Cited by 110 publications

References 0 publications

Auxiliary liver transplantation: how to improve regeneration of the native liver by surgery

Auxiliary liver transplantation: how to improve regeneration of the native liver by surgery

Intensive Care Management of Patients Prior to Liver Transplantation

Auxiliary heterotopic liver transplantation with portal vein arterialization for fulminant hepatic failure

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