Liver transplantation as a lifesaving procedure for posthepatectomy liver failure and iatrogenic liver injuries

Abstract

Background Iatrogenic injuries to vital structures of the liver and posthepatectomy liver failure are associated with high mortality. The current donor situation in Norway allows liver transplantation of patients beyond conventional criteria. Methods From 1984 to 2017, a total of 1510 liver transplantations were performed. In this retrospective study, we report the results of 13 patients undergoing liver transplantation due to iatrogenic injuries to the liver vasculature or posthepatectomy liver failure. Results Twelve men and one woman with a median age of 55 years (range 22-69) were included. Seven patients underwent radical surgery for cancer prior to transplantation. The median follow-up time was 70.5 months (range 2.2-177). Three of the patients with malignant disease did not experience disease recurrence, whereas four patients had cancer recurrence and died 7, 24, 45, and 78 months after transplantation. Five of six patients with non-malignant disease fully recovered, but one patient died after 9 months due to infectious complications. Conclusions Liver transplantation for liver failure due to portal vein and hepatic artery injury in patients with nonmalignant disease seems justified. However, it may be questioned whether patients with malignant disease beyond established criteria should be offered liver transplantation.

Systematic review of MARS treatment in post-hepatectomy liver failure

“…A recent publication by Thorsen et al could demonstrate the feasibility of liver transplantation to overcome PHLF if organ shortage isn't an issue. 42 Living donor liver transplantation could be an option when extended criteria are accepted.…”

Current evidence on posthepatectomy liver failure: comprehensive review

“…Liver transplantation is frequently stated to be the only definite treatment in patients with PHLF; however, the scientific evidence is low, and there are many obvious limitations. So far, three articles have described the experience with LTx in PHLF, two single-centre series 216 , 217 and a recent multicentre experience 218 . All concluded that it is safe and feasible to offer LTx to patients with PHLF with good long-term outcomes comparable to LTx for established indications; however, there are many unanswered questions such as the optimal time point for LTx and how to justify this indication in light of donor organ shortages.…”

Liver transplantation in patients with post-hepatectomy liver failure – A Northern European multicenter cohort study

“…We have no obvious explanation for this. In the series reported by Otsuka et al, 14 five out of 7 patients were male and in the Oslo experience reported by Thorsen et al 15 out of 13 patients (five of which are included in the present study) were offered LTX for PHLF.…”

“…Despite this, LTX has been described in a limited number of scientific publications as a rescue option for PHLF patients. 14,15 However, several important questions remain unanswered.…”