Auxiliary liver transplantation for fulminant and subfulminant hepatic failure.

Details

Serval ID
serval:BIB_9B4C1B6E359D
Type
Article: article from journal or magazin.
Collection
Publications
Title
Auxiliary liver transplantation for fulminant and subfulminant hepatic failure.
Journal
Transplantation
Author(s)
Boudjema K., Cherqui D., Jaeck D., Chenard-Neu M.P., Steib A., Freis G., Becmeur F., Brunot B., Simeoni U., Bellocq J.P.
ISSN
0041-1337 (Print)
ISSN-L
0041-1337
Publication state
Published
Issued date
1995
Peer-reviewed
Oui
Volume
59
Number
2
Pages
218-223
Language
english
Notes
Publication types: Clinical Trial ; Journal Article Publication Status: ppublish
Abstract
We report the first series of 9 auxiliary liver transplantations performed as a bridge to recovery in 8 patients with fulminant and subfulminant hepatic failure. Hepatic failure was due to hepatitis A virus (n = 3), hepatitis B virus (n = 1), hepatotoxic drugs (n = 2), autoimmune disease (n = 1), or it was of unknown origin (n = 1). The donor liver was reduced to a left lobe (n = 2), a left liver (n = 4), or a right liver (n = 3), and was implanted in an orthotopic position beside the native liver after it was resected by a left or a right hepatectomy. Conventional immunosuppression was used to prevent rejection. Six patients regained normal consciousness within 2 weeks, without any sequelae. Two patients had persisting encephalopathy due to graft initial dysfunction, one of whom showed portal vein thrombosis, which was successfully cleared. The other one showed hepatic vein stenosis and was retransplanted at day 15. Five of eight patients had to be reoperated because of a surgical complication. Five patients showed rapid regeneration of their native liver, but one died at day 45 from severe herpes virus broncholitis. The auxiliary grafts were removed (n = 3) or left to atrophy by tapering immunosuppression (n = 1). One patient developed cirrhosis of the native liver and died of infectious complications at day 42. The native livers of the two remaining patients are still atrophic, one at 4 months and one at 1 month posttransplant. Finally, 6 of 8 patients are alive with a follow-up of 1 to 17 months. Four of them have permanently stopped their immunosuppressive therapy. Our experience demonstrates that auxiliary orthotopic liver transplantation (1) is feasible in children and adults, using either a left or a right liver graft, (2) is efficient in providing adequate liver function, and (3) gives a real chance to the native liver to regenerate, offering these patients a future free of immunosuppression.
Keywords
Adolescent, Adult, Aged, Child, Child, Preschool, Female, Hepatic Encephalopathy/surgery, Humans, Liver/physiology, Liver Regeneration, Liver Transplantation/methods, Male, Middle Aged, Postoperative Period
Pubmed
Web of science
Create date
22/02/2015 8:56
Last modification date
20/08/2019 15:02
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