Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases

Abstract

Ex vivo liver resection combined with autotransplantation is a recently introduced approach to cure end‐stage hepatic alveolar echinococcosis (HAE), which is considered unresectable by conventional radical resection due to echinococcal dissemination into the crucial intrahepatic conduits and adjacent structures. This article aims discuss the manipulation details and propose reasonable indications for this promising technique. All patients successfully underwent liver autotransplantation with no intraoperative mortality. The median weight of the autografts was 636 g (360‐1300 g), the median operation time was 12.5 hours (9.4‐19.5 hours), and the median anhepatic phase was 309 minutes (180‐ 460 minutes). Intraoperative blood loss averaged 1800 mL (1200‐6000 mL). Postoperative complications occurred in 13 patients during hospitalization; 5 patients experienced postoperative complications classified as Clavien‐Dindo grade III or higher, and 2 patients died of intraabdominal bleeding and acute cerebral hemorrhage, respectively. Twenty‐nine patients were followed for a median of 14.0 months (3‐42 months), and no HAE recurrence was detected. The technique requires neither an organ donor nor any postoperative immunosuppressant, and the success of the treatment relies on meticulous preoperative assessments and precise surgical manipulation.

Quantitative evaluation of range and metabolic activity of hepatic alveolar echinococcosis lesion microenvironment using PET/CT and multi-site sampling method

“…Besides, achieving 2 cm resection margin for every single lesion is not possible in most advanced cases as recommended [3,4,28,30]. For excessive vascular in ltrated lesion or with severe comorbidities, only liver transplantation or ex vivo liver resection and autotransplantation could be selected from the perspective surgical treatment [11,[31][32][33][34][35][36][37][38][39][40]. Our data indicated that, different lesion types had different immune cell in ltrated belt.…”

Ex vivo liver resection and autotransplantation versus allotransplantation for end-stage hepatic alveolar echinococcosis

“…Patients with the following features underwent ERAT: (1) two or more porta hepatis were invaded; (2) involvement of the RHVC was 50% of the circumference and 3 cm of the longitudinal diameter; (3) infiltration was above the diaphragm and/or extended to the right atrium; (4) the residual liver volume (RLV) was more than 35% of the standard liver volume (SLV); and (5) the total bilirubin value was no more than twice the upper limit of normal for patients with biliary obstruction. Details of the ERAT procedure have been reported previously (Yang et al, 2018).…”

“…When the disease progresses to the advanced stage with extensive invasion of the extra-and intrahepatic vasculature, conventional radical resection becomes extremely hazardous because of the potential risk of uncontrollable hemorrhage and long ischemia time. Several unconventional methods have been used to address this complicated situation, including allotransplantation (Sulima et al, 2016) and ex vivo liver resection and autotransplantation (ERAT) (Yang et al, 2018).…”

“…Nevertheless, there are inherent disadvantages of allotransplantation: recurrence of the disease associated with immunosuppressive therapy and the shortage of donors. Recently, other centers, including the present authors' center, have started to use the ERAT technique, in which the entire liver is removed, the parasitic lesions are resected ex vivo, and the remaining liver is returned to the patient (Yang et al, 2018;Wen et al, 2016). In this manner, postoperative immunosuppressive drug treatment can be avoided.…”

Resection of retrohepatic inferior vena cava without reconstruction in ex vivo liver resection and autotransplantation: a retrospective study

“…An increasing number of new ideas support the superior long-term efficacy of ERAT in treating hepatic alveolar echinococcosis (HAE) or benign liver tumors compared to that of allogeneic liver transplantation [4,5] . In patients with HAE with partial or complete occlusion of the RIVC before surgery, if the imaging evaluation shows a rich collateral circulation, RIVC reconstruction may not be performed according to the actual situation [2] . However, there have been few relevant previous studies and no long-term outcome studies, and most related studies have examined primary IVC tumors [6,7] .…”