Auxillary partial orthotopic living donor liver transplantation as an aid for small-for-size grafts in larger recipients

Citation
Y. Inomata et al., Auxillary partial orthotopic living donor liver transplantation as an aid for small-for-size grafts in larger recipients, TRANSPLANT, 67(10), 1999, pp. 1314-1319
Citations number
9
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Medical Research Diagnosis & Treatment
Journal title
TRANSPLANTATION
ISSN journal
0041-1337 → ACNP
Volume
67
Issue
10
Year of publication
1999
Pages
1314 - 1319
Database
ISI
SICI code
0041-1337(19990527)67:10<1314:APOLDL>2.0.ZU;2-F
Abstract
Background. In countries where living donors are the only source of liver g rafts, restrictions on graft size are a serious obstacle for the expansion of indications for adult recipients. To overcome this problem, auxiliary pa rtial orthotopic liver transplants (APOLT*) was performed on the basis of t he concept that the residual native liver would support the graft function until the graft had grown enough to function by itself. Methods. APOLT as an aid for small-for-size (SFS) grafts was reviewed retro spectively to evaluate its feasibility. Between April 1995 and March 1998, 20 recipients underwent APOLT, which was indicated because of a SFS graft i n 15 of them. The indication was based on the estimated graft/recipient's b ody weight ratio (GRWR). If the ratio was <0.8%, APOLT was performed. The o ther 5 patients had a graft with a GRWR >0.8% and underwent APOLT on the ba sis of the residual native liver supporting the graft function temporarily, 4 for supplementation of the defective enzyme in metabolic liver diseases and one for leaving the potential of the regeneration of the native liver i n fulminant hepatic failure, The recipients who underwent APOLT because of a SFS graft were categorized as the SFS group, and the others were the seco nd group. Results. In the SFS group, the age of the recipients ranged from 13 to 48 ( median 23), The original indications of this group were fulminant hepatic f ailure in 2 recipients, acute deterioration of chronic liver diseases in 3, Wilson's disease in 2, biliary atresia in 4, primary biliary cirrhosis in 3, and primary sclerosing cholangitis (PSC) in one. The actual GRWR ranged from 0.45 to 0.72 (median 0.55), The graft was implanted after resection of the left lateral segment of the native liver, Except in the first two pati ents, the portal vein to the residual native liver was completely transecte d so that all of the portal blood drained into the graft liver. This proced ure was successful in 9 patients. The cause of death in the other 6 was mai nly infection. The mortality rate among the recipients with signs of advanc ed liver failure, such as massive ascites or hepatic coma, was higher, even though APOLT was used to support the SFS graft. In the second group, in th e other five recipients who underwent APOLT for other indications, one reci pient with fulminant hepatic failure died of sepsis caused by the dehiscenc e of bilio-enteric anastomosis. Conclusions. APOLT as an aid for a SFS graft is technically viable. This pr ocedure can thus expand the indication of living donor liver transplants fo r adult recipients when the native liver retains some functional capability to support the grafted liver during the immediate postoperative period.