contributed to this work equally.The role of autotransplantation in end-stage hepatic alveolar echinococcosis (AE) is unclear. We aimed to present our 15-case experience and propose selection criteria for autotransplantation. All patients were considered to have unresectable hepatic AE by conventional resection due to critical invasion to retrohepatic vena cava, hepatocaval region along with three hepatic veins, and the tertiary portal and arterial branches. All patients successfully underwent ex vivo extended right hepatectomy and autotransplantation without intraoperative mortality. The median autograft weight was 706 g (380-1000 g); operative time was 15.5 hours (11.5-20.5 hours); and anhepatic time was 283.8 minutes (180-435 min). Postoperative hospital stay was 32.3 days (12-60 days). Postoperative complication Clavien-Dindo grade IIIa or higher occurred in three patients including one death that occurred 12 days after the surgery due to acute liver failure. One patient was lost to follow-up after the sixth month. Thirteen patients were followed for a median of 21.6 months with no relapse. This is the largest reported series of patients with end-stage hepatic AE treated with liver autotransplantation. The technique requires neither organ donor nor postoperative immunosuppressant. The early postoperative mortality was low with acceptable morbidity. Preoperative precise assessment and strict patient selection are of utmost importance.
versity, China Background: Ex situ liver resection and autotransplantation (ESLRA) technique have been applied in cases with hepatocaval region involvement. Despite the relative high morbidity and mortality in most reports, the technique was adopted by high volume centers. Methods: This systematic review analyze the current data regarding the feasibility, safety, and oncological efficacy of ESLRA. A meta-analysis of conversion to allotransplant, 90-day mortality, feasibility, and complication was performed. Results: A literature search revealed a total of 36 publications that met criteria, reporting data from 140 patients (82 autotransplantation, 53 ante-situm). Evidence levels were low, with highest Oxford evidence level being 4. The most common indication was colorectal liver metastasis in 36 patients. The conversion to allotransplantation rate was 5.7% (CI 2e30%), 90-day mortality 10% (CI 5e34%), in hospital mortality 10.7%, overall complication rate 36.4% (8e66%), and complications grade IIIa or higher occurred in 22% (CI 8e 87%). A standardized and unified nomenclature of this surgical technique is lacking. A standardized reporting format for complications is lacking despite the widespread use of Clavien-Dindo classification. Oncological outcome is not well documented. The most commonly topic is technical feasibility and indications for the surgical procedure. Publication bias is common due to the case series and single center report. Conclusion: The increased risk associated with the procedure appears to be balanced by the possible benefits, particularly when the lack of alternative curative approaches is considered. A unified nomenclature system with a systematic exploration with a rigid methodology such as registry analysis is strongly recommend.
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