Liver transplantation as a lifesaving procedure for posthepatectomy liver failure and iatrogenic liver injuries
Iatrogenic injuries to vital structures of the liver and posthepatectomy liver failure are associated with high mortality. The current donor situation in Norway allows liver transplantation of patients beyond conventional criteria.
From 1984 to 2017, a total of 1510 liver transplantations were performed. In this retrospective study, we report the results of 13 patients undergoing liver transplantation due to iatrogenic injuries to the liver vasculature or posthepatectomy liver failure.
Twelve men and one woman with a median age of 55 years (range 22–69) were included. Seven patients underwent radical surgery for cancer prior to transplantation. The median follow-up time was 70.5 months (range 2.2–177). Three of the patients with malignant disease did not experience disease recurrence, whereas four patients had cancer recurrence and died 7, 24, 45, and 78 months after transplantation. Five of six patients with non-malignant disease fully recovered, but one patient died after 9 months due to infectious complications.
Liver transplantation for liver failure due to portal vein and hepatic artery injury in patients with non-malignant disease seems justified. However, it may be questioned whether patients with malignant disease beyond established criteria should be offered liver transplantation.
KeywordsLiver transplantation Rescue Iatrogenic injuries Posthepatectomy liver failure
T.T: Study conception and design, acqusition of data, analysis and interpretetation of data and drafting of manuscript. J.M.S.: Acqusition of data and drafting of manuscript. K.J.L: Study conception and design, and critical revision of manuscript. P-D.L: Study conception and design, and critical revision of manuscript. E.M.AA: Study conception and design, analysis and interpretetation of data and drafting of manuscript. All authors have approved the final article.
Compliance with ethical standards
The authors of this manuscript have no conflicts of interest to disclose.
The study was approved by the institutional review board according to the general guidelines provided by the regional ethics committee (2015/1442). For this type of study formal consent is not required (retrospective study).
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 3.Fernandez JA, Robles R, Marin C, Sanchez-Bueno F, Ramirez P, Parrilla P (2004) Laparoscopic iatrogeny of the hepatic hilum as an indication for liver transplantation. Liver Transplantation: Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Liver Transpl 10(1):147–152. https://doi.org/10.1002/lt.20021
- 4.Zaydfudim V, Wright JK, Pinson CW (2009) Liver transplantation for iatrogenic porta hepatitis transection. Am Surg 75(4):313–316Google Scholar
- 5.Ardiles V, McCormack L, Quinonez E, Goldaracena N, Mattera J, Pekolj J, Ciardullo M, de Santibanes E (2011) Experience using liver transplantation for the treatment of severe bile duct injuries over 20 years in Argentina: results from a National Survey. HPB: Off J Int Hepato Pancreato Biliary Assoc 13(8):544–550. https://doi.org/10.1111/j.1477-2574.2011.00322.x CrossRefGoogle Scholar
- 8.Leale I, Moraglia E, Bottino G, Rachef M, Dova L, Cariati A, De Negri A, Diviacco P, Andorno E (2016) Role of liver transplantation in bilio-vascular liver injury after cholecystectomy. Transplant Proc 48(2):370–376. https://doi.org/10.1016/j.transproceed.2015.12.035 CrossRefGoogle Scholar
- 10.Di Benedetto F, Mimmo A, D'Amico G, De Ruvo N, Cautero N, Montalti R, Guerrini GP, Ballarin R, Spaggiari M, Tarantino G, Serra V, Pecchi A, De Santis M, Gerunda GE (2010) Liver transplantation due to iatrogenic injuries: two case reports. Transplant Proc 42(4):1375–1377. https://doi.org/10.1016/j.transproceed.2010.03.077 CrossRefGoogle Scholar
- 13.Aseni P, Lauterio A, Slim AO, Giacomoni A, Lamperti L, De Carlis L (2010) Life-saving super-urgent liver transplantation with replacement of retrohepatic vena cava by dacron graft. HPB Surg: World J Hepatic, Pancreatic Biliary Surg 2010:1–4. https://doi.org/10.1155/2010/828326 CrossRefGoogle Scholar
- 14.Hagness M, Foss A, Line PD, Scholz T, Jorgensen PF, Fosby B, Boberg KM, Mathisen O, Gladhaug IP, Egge TS, Solberg S, Hausken J, Dueland S (2013) Liver transplantation for nonresectable liver metastases from colorectal cancer. Ann Surg 257(5):800–806. https://doi.org/10.1097/SLA.0b013e3182823957 CrossRefGoogle Scholar
- 16.Dueland S, Hagness M, Line PD, Guren TK, Tveit KM, Foss A (2015) Is liver transplantation an option in colorectal cancer patients with nonresectable liver metastases and progression on all lines of standard chemotherapy? Ann Surg Oncol 22(7):2195–2200. https://doi.org/10.1245/s10434-014-4137-0 CrossRefGoogle Scholar
- 27.McPhail MJ, Farne H, Senvar N, Wendon JA, Bernal W (2016) Ability of King’s College Criteria and model for end-stage liver disease scores to predict mortality of patients with acute liver failure: a meta-analysis. Clinical Gastroenterology and Hepatology: the Official Clinical Practice Journal of the American Gastroenterological Association. Clin Gastroenterol Hepatol 14(4):516–525.e515; quiz e543-e545. https://doi.org/10.1016/j.cgh.2015.10.007
- 28.Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, Koch M, Makuuchi M, Dematteo RP, Christophi C, Banting S, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Yokoyama Y, Fan ST, Nimura Y, Figueras J, Capussotti L, Buchler MW, Weitz J (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149(5):713–724. https://doi.org/10.1016/j.surg.2010.10.001 CrossRefGoogle Scholar
- 29.Toso C, Pinto Marques H, Andres A, Castro Sousa F, Adam R, Kalil A, Clavien PA, Furtado E, Barroso E, Bismuth H (2017) Liver transplantation for colorectal liver metastasis: survival without recurrence can be achieved. Liver Transpl: Off Publ Am Assoc Stud Liver Dis Int Liver Transpl Soc 23(8):1073–1076. https://doi.org/10.1002/lt.24791 CrossRefGoogle Scholar