Auxiliary liver transplantation: Regeneration of the native liver and outcome in 30 patients with fulminant hepatic failure-a multicenter European study

Chenard-Neu, Marie-Pierre; Boudjéma, Karim; Bernuau, Jacques; Degott, Claude; Belghiti, Jacques; Cherqui, Daniel; Costes, V; Domergue, J; Durand, François; Erhard, J; Hemptinne, Bernard de; Gubernatis, G.; Hadengue, A; Kemnitz, J; McCarthy, Michelle; Maschek, H.; Mentha, Gilles; Oldhafer, Karl J.; Portmann, Bernard; Praet, Marleen; Ringers, J.; Rogiers, Xavier; Rubbia, L; Schalm, Solko W.; Kate, F.J.W. ten; Ot, Terpstra; Hoek, Bart van; Williams, Roger; Zafrani, Élie Serge; Cinqualbre, J; Wolf, Philippe; Jaeck, Daniel; Bellocq, J P

doi:10.1002/hep.510230528

Cited by 105 publications

(78 citation statements)

References 16 publications

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“…In terms of large-scale trials, a multicenter European study of auxiliary liver transplantation was reported by Chenard-Neu et al (6). This study included 30 patients with fulminant hepatic failure, 24 of whom underwent APOLT.…”

Section: Discussionmentioning

confidence: 99%

“…Auxiliary partial orthotopic liver transplantation (APOLT) has recently been performed in patients with acute liver failure and who developed neurologic complications such as fulminant hepatitis accompanied by hepatic coma (2-7) and in patients with noncirrhotic metabolic diseases such as ornithine carbamoyltransferase deficiency (8). In the former, especially in young patients, recovery of liver function and full regeneration of liver cells of the native liver, as well as the eventual withdrawal of immunosuppression, can be expected (6). Auxiliary heterotopic liver transplantation for fulminant hepatitis has antedated APOLT (9,10).…”

mentioning

confidence: 99%

“…Liver cell regeneration after massive hepatic necrosis as a result of fulminant hepatitis has not been pathologically examined in detail because most patients have had a fatal course; even if they had survived, biopsy examination often would have been life threatening because of hemorrhagic diathesis. Recently, however, it has been shown that liver cell regeneration after necrosis can be observed in the native liver after APOLT (2,(5)(6)(7), and there have been a limited number of reports describing regenerative liver cells in fulminant hepatitis in APOLT. In these reports, ductular hepato-cytes were considered to be the putative progenitor cells of hepatocytes (11)(12)(13)(14).…”

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confidence: 99%

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Sequential Observation of Liver Cell Regeneration after Massive Hepatic Necrosis in Auxiliary Partial Orthotopic Liver Transplantation

et al. 2000

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The morphogenesis of hepatocytes after massive hepatic necrosis to recovery through liver cell regeneration has not been fully understood. Sequential biopsies were performed on the native liver of a 22-year-old man who underwent auxiliary partial orthotopic liver transplantation 1 month after fulminant hepatitis. Auxiliary partial orthotopic liver transplantation was successful, and the biopsy samples permitted us to examine the regenerating process of hepatocytes after massive necrosis. At the time of auxiliary partial orthotopic liver transplantation (postoperative day 0), 95% of hepatocytes were lost and a few ductules were found in the portal areas. The ductules stained with cytokeratin 19. At postoperative day 7, the ductules began to increase in size and number and became dilated over a period of 1 month, when individual hepatocytes with clear cytoplasm appeared from the ductules. As the differentiation of hepatocytes increased, the expression of cytokeratin 19 was found to decrease. From 2 to 3 months, all of the ductules were transformed into hepatocytes, and they began to form round cell clusters. From 3 to 6 months, the round cell clusters became organized into trabecula with fibrosis. From 6 to 12 months, a lobular architecture was established, and by 14 months, the necrotic liver was fully recovered to normal. This study by examination of sequential biopsies demonstrates the progression of the regenerating process from total hepatic necrosis to complete recovery.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Sequential Observation of Liver Cell Regeneration after Massive Hepatic Necrosis in Auxiliary Partial Orthotopic Liver Transplantation

et al. 2000

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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%

“…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]. The ALT technique is less standardized than OLT, as the early and later roles of the auxiliary graft are contradictory in some respects.…”

Section: Introductionmentioning

confidence: 99%

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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Acute Liver Failure and Related Syndromes

Durand¹,

Bernuau²

2007

Textbook of Hepatology

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Auxiliary liver transplantation: Regeneration of the native liver and outcome in 30 patients with fulminant hepatic failure-a multicenter European study

Cited by 105 publications

References 16 publications

Sequential Observation of Liver Cell Regeneration after Massive Hepatic Necrosis in Auxiliary Partial Orthotopic Liver Transplantation

Sequential Observation of Liver Cell Regeneration after Massive Hepatic Necrosis in Auxiliary Partial Orthotopic Liver Transplantation

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

Acute Liver Failure and Related Syndromes

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