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Auxiliary Partial Orthotopic Liver Transplantation for Acute Liver Failure: Not Supportive Enough?

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Abstract

Auxiliary partial orthotopic liver transplantation (APOLT) entails the removal of part of the native liver and replacement with the corresponding part of donor liver. APOLT is usually performed for acute liver failure and metabolic liver disease. However, many technical concerns limit its acceptance globally. In this study, we describe our experience of 6 APOLT performed for acute liver failure. Out of the 68 liver transplants performed in our center for acute liver failure, six were APOLT. APOLT was performed in the setting of hyperacute liver failure with no other organ failure. The recovery of the native liver was assessed using hepatobiliary scintigraphy every six months. Immunosuppressant withdrawal was attempted once 50% recovery of the native liver was attained in the scan. All donors were first-degree relatives. Etiology was hepatitis A in 4 patients, yellow phosphorous poisoning in 1, and cryptogenic fulminant hepatic failure in the remaining 1 patient. Five of them were blood group identical and one was ABO incompatible (AB to A). Post-operatively, three patients died, two due to massive cerebral edema, and one due to sepsis. All the survivors at a follow-up period of 2 years are off immunosuppressants and are doing well. Auxiliary liver transplant in acute liver failure has a poor success rate. However, the technique can be considered in a very selected group of patients with hepatitis A-related hyperacute liver failure.

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Yes.

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NA.

Abbreviations

APOLT:

Auxiliary partial orthotopic liver transplantation

TPN:

Total parenteral nutrition

ALF:

Acute liver failure

GRWR:

Graft to recipient weight ratio

PvP1 :

Portal venous pressure to the graft liver

PvP2:

Portal venous pressure to the native liver

HIDA:

Hepatobiliary iminodiacetic acid scan

MRI:

Magnetic resonance imaging

EEG:

Electroencephalogram

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery & Solid Organ Transplant, Amrita Institute of Medical Sciences & Research Centre, Amrita University, Kochi, Kerala, 682041, India

    S. T. Binoj, Johns Shaji Mathew, Krishnanunni Nair, Shweta Mallick, Christi Titus Varghese, Biju Chandran, Ramachandran Narayana Menon, Dinesh Balakrishnan, Unnikrishnan Gopalakrishnan, O. V. Sudheer & Sudhindran Surendran

  2. Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India

    M. Abdul Razak & Padma Uma Devi

Authors
  1. S. T. Binoj
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  2. Johns Shaji Mathew
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  3. M. Abdul Razak
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  4. Krishnanunni Nair
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  5. Shweta Mallick
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  6. Christi Titus Varghese
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  7. Biju Chandran
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  8. Ramachandran Narayana Menon
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  9. Dinesh Balakrishnan
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  10. Unnikrishnan Gopalakrishnan
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  11. Padma Uma Devi
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  12. O. V. Sudheer
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  13. Sudhindran Surendran
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Contributions

B.S.T and M.A.R are responsible for the design of the study, collection of data, writing the first draft, and is responsible for the accuracy and integrity of the work. J.S.M. is responsible for writing the final manuscript, final approval of the submission of the article, and is responsible for the accuracy and integrity of the work. KU, SM, CTV, BC, UG, DB, RCN, and S.O.V. participated in the design of the study and revision of the manuscript. P.U.D participated in the design of the study, final approval of the submission of the article, and revision of the manuscript. S.S. is responsible for the design of the study, revision of the manuscript, final approval of the submission of the article, and is responsible for the integrity of the work.

Corresponding author

Correspondence to Johns Shaji Mathew.

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The authors affirm that the study was performed in a manner confirming with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and that the authors followed the policy concerning informed consent as shown in Springer.com

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Conflict of Interest

BST, MAR, JSM, KU, SM, CTV, BC, UG, DB, RCN, PUD, and SS declare that they have no conflict of interest.

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Binoj, S.T., Mathew, J.S., Razak, M.A. et al. Auxiliary Partial Orthotopic Liver Transplantation for Acute Liver Failure: Not Supportive Enough?. Indian J Surg 84 (Suppl 2), 424–430 (2022). https://doi.org/10.1007/s12262-021-02925-9

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  • DOI: https://doi.org/10.1007/s12262-021-02925-9

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