Auxiliary Partial Liver Transplantation for End-Stage Chronic Liver Disease

Abstract

Auxiliary heterotopic liver transplantation is theoretically attractive because it leaves the recipient's liver in place. The surgical trauma of hepatectomy is avoided, and failure of the graft does not necessarily lead to the death of the patient or a second, emergency transplantation. Another advantage is that matching the body sizes of the donor and the recipient is not mandatory, which increases the number of possible donors. However, previous clinical results of auxiliary liver transplantation have been poor. We performed auxiliary partial liver transplantation in six consecutive patients with end-stage chronic liver disease who were not accepted for orthotopic liver transplantation because they had massive ascites, deficient clotting function, cachexia, or poor pulmonary reserve. The donor liver was transplanted to the right subhepatic region after removal of segments II and III, and it was provided with portal and arterial blood. There were no major changes in hemodynamic measurements during surgery. The mean hospital stay after transplantation was 22.7 days (range, 14 to 29). After a mean follow-up period of 14 months (range, 5 to 23), all patients were alive, with good graft function as demonstrated by scintigraphy, Doppler ultrasonography, and synthesis of clotting factors. From these observations we conclude that auxiliary partial liver transplantation is an attractive alternative to orthotopic liver transplantation in high-risk patients. Its role in other patients who need liver transplants remains to be defined.

Technique of hepatic arterial anastomosis in living donor pediatric auxiliary partial orthotopic liver transplantation

“…1 The standard technique of arterial reconstruction in deceased donor APOLT uses a cadaveric iliac artery conduit, which brings inflow from the supraceliac aorta, infrarenal aorta, splenic artery, or gastroduodenal artery. 1,[10][11][12] In the setting of adult living donor APOLT, a direct anastomosis between the donor's right hepatic artery and the recipient's right hepatic artery is feasible. However, in pediatric living donor APOLT, a discrepancy between the donor and recipient arteries is common.…”

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“…3 Auxiliary liver transplant is a technique in which the donor liver graft is placed alongside the native liver without native liver resection (heterotopic) or after resection of part of the native liver, replacing it with a segmental graft (orthotopic). In 2008, we reported the long-term survival of our first patient with heterotopic segmental auxiliary liver transplant and who is still alive with good graft function.…”

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

“…5,6,9 Heterotopic liver transplantation was used in the early times of liver transplantation; it was technically easier because native hepatectomy was avoided. 11 It was abandoned because of problems of venous outflow obstruction, lack of sufficient space in the abdomen, and competition for portal venous flow between the graft and NL. 12 Recently, AHLT was reintroduced for auxiliary temporary support in cases of fulminant hepatic failure.…”