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Auxiliary Liver Transplantation

  • Nigel D. HeatonEmail author
Chapter
Part of the Springer Surgery Atlas Series book series (SPRISURGERY)

Abstract

The healthy human liver is remarkable in that it retains its ability to regenerate effectively, even after severe injury, throughout life. However, patients with the most severe forms of injury or disease may die from complications before effective regeneration can take place. Auxiliary liver transplantation (ALT) restores liver function in such patients, allowing time for the native liver to regenerate and if successful for subsequent withdrawal of immunosuppression. This procedure is becoming established as the optimal treatment for young patients with severe acute liver failure. The surgery is technically more difficult than orthotopic liver transplantation. Donor and recipient selection is critical in ensuring that patient survival is equivalent to that obtained with orthotopic liver transplantation. Most ALT survivors experience satisfactory regeneration and are able to withdraw from immunosuppression, thus avoiding the risks of long-term immunosuppression, including infection, nephropathy, malignancy, and graft failure. With increasing interest and experience, this technique is being performed more often, particularly in children, with good outcomes. ALT has also been used to treat non-cirrhotic inborn errors of metabolism primarily based in the liver, and a few publications have reported its use for sensitised renal transplant recipients, but to date these uses have not been accepted as established therapies. These indications are not considered further in this chapter.

Keywords

Auxiliary liver transplantation Liver transplantation Liver regeneration Immunosuppression 

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Liver StudiesKing’s College Hospital NHSFTLondonUK

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