Liver Transplantation for Unresectable Hepatic Alveolar Echinococcosis

Abstract

The aim of the investigation was to assess the immediate and long-term results of the liver transplantation in patients with unresectable hepatic alveolar echinococcosis.Materials and Methods. 22 liver transplantations were performed in the Center for Surgery and Transplantology of the A.I. Burnazyan Federal Medical and Biophysical Center between January 2011 and December 2016 for unresectable liver disease. Liver segments (the right liver lobe in all cases) from living related donors were transplanted to 21 patients, a posmortal donor liver was transplanted to 1 female patient. 16 patients (72.7%) had parasitic invasion of the inferior vena cava. All operations were done in R0 variant. Reconstruction of the great vessels was performed by synthetic PTFE-conduits if autoplasty was not feasible.Results. The duration of surgery was 430 (390-480) min. The intraoperative blood loss amounted to 1,500 (1,300-2,200) ml, cold ischemia lasted 30 (25-45) min. The morbidity rate of postoperative complications made up 45.4%. Biliary complications (Grade A, B, ISGLS, 2011) prevailed. Mortality rate was equal to 4.5%. The length of postoperative hospital stay averaged out to 20 (15-23.5) bed days. Long-term survival rate comprised 100%. Maximal follow-up period was 58 months.Conclusion. Liver transplantation with resection and reconstruction of the great vessels, including resection of the inferior vena cava and even the right atrium, may be the only radical method of treating unresectable hepatic alveolar echinococcosis, making it possible to provide satisfactory immediate and long-term results of surgical treatment of the patients seemingly doomed to death. These interventions should be performed only in highly specialized centers with a developed program of surgical hepatology and liver transplantation.

The importance of uninterrupted albendazole treatment in patients with unresectable alveolar echinococcosis undergoing liver transplantation

“…To date, significant data have been accumulated regarding liver transplantation (LT) in patients with unresectable AE. Descriptions of successful LT in such cases relate mainly to the technique during surgery and the patient survival time 2‐5 . However, when the primary lesion is removed along with the affected liver, metastases to other organs are often found.…”

“…Descriptions of successful LT in such cases relate mainly to the technique during surgery and the patient survival time. [2][3][4][5] However, when the primary lesion is removed along with the affected liver, metastases to other organs are often found.…”

Possibilities of Computed Tomography in the Planning of Inferior Vena Cava Resection in Patients with Liver Alveococcosis

“…Оценка вовлечения НПВ при локализации патологического процесса в гепатокавальной области является одним из важных этапов при планировании оперативного вмешательства. Необходимость резекции НПВ может потребовать ее протезирования в условиях полного прекращения печеночного кровотока, а в случае недостаточного оперативного доступа операция проводится по типу ex situ [10,11]. Компьютерная томография (КТ) в ходе одного исследования позволяет получить информацию о состоянии печени, исключить внепеченочное распространение процесса, оценить сосудистую анатомию и провести волюметрию будущего остатка печени [12,13].…”