Auxiliary partial orthotopic liver transplantation in the treatment of acute liver failure: A case report

Lee, D. S.; Woo, Jae-Gon; Lee, H. H.; Lee, Kwang‐Woong; Joh, Jae‐Won; Kim, S. J.; Choi, Sang Hyun; Heo, Jin Seok; Hyon, Won-Sok; Kim, G. S.; Lee, S. K.

doi:10.1016/j.transproceed.2004.08.072

Cited by 3 publications

(4 citation statements)

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“…Additionally, 36 reports of 20 studies11, 13, 15, 16, 18, 20, 21, 23, 28–34, 39, 43, 44, 46, 47, 51–58, 65, 66, 76, 77, 81, 82, 87, 90 provided sufficient information to calculate the prevalence of MTB in liver transplant recipients, and 15 reports of 7 studies15, 16, 43–46, 51–53, 55, 61, 62, 91–93 evaluated latent MTB treatment in liver transplant candidates or recipients. We excluded 15 studies with pretransplant active MTB patients who developed fulminant hepatic failure requiring transplant due to MTB drug therapy 94–108…”

Section: Resultsmentioning

confidence: 99%

Tuberculosis in liver transplant recipients: A systematic review and meta-analysis of individual patient data

et al. 2009

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AZMycobacterium tuberculosis (MTB) causes substantial morbidity and mortality in liver transplant recipients. We examined the efficacy of isoniazid latent Mycobacterium tuberculosis infection (LTBI) treatment in liver transplant recipients and reviewed systematically all cases of active MTB infection in this population. We found 7 studies that evaluated LTBI treatment and 139 cases of active MTB infection in liver transplant recipients. Isoniazid LTBI treatment was associated with reduced MTB reactivation in transplant patients with latent MTB risk factors (0.0% versus 8.2%, P ϭ 0.02), and isoniazid-related hepatotoxicity occurred in 6% of treated patients, with no reported deaths. The prevalence of active MTB infection in transplant recipients was 1.3%. Nearly half of all recipients with active MTB infection had an identifiable pretransplant MTB risk factor. Among recipients who developed active MTB infection, extrapulmonary involvement was common (67%), including multiorgan disease (27%). The short-term mortality rate was 31%. Surviving patients were more likely to have received 3 or more drugs for MTB induction therapy (P ϭ 0.003) and to have been diagnosed within 1 month of symptom onset (P ϭ 0.01) and were less likely to have multiorgan disease (P ϭ 0.01) or to have experienced episodes of acute transplant rejection (P ϭ 0.02). Compared with the general population, liver transplant recipients have an 18-fold increase in the prevalence of active MTB infection and a 4-fold increase in the case-fatality rate. For high-risk transplant candidates, isoniazid appears safe and is probably effective at reducing MTB reactivation. All liver transplant candidates should receive a tuberculin skin test, and isoniazid LTBI treatment should be given to patients with a positive skin test result or MTB pretransplant risk factors, barring a specific contraindication. Liver Transpl 15:894-906, 2009.

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Section: Resultsmentioning

confidence: 99%

Tuberculosis in liver transplant recipients: A systematic review and meta-analysis of individual patient data

et al. 2009

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“…The portal vein modification also decreases the risk of thrombosis, which was shown to occur more frequently in APOLT in 1 study . Maximizing portal inflow to the graft is important because the native liver often outcompetes the graft for portal flow, sometimes leading to failure . In FHF, however, the opposite is true because of the increased presinusoidal pressure resulting from necrosis, further favoring the graft initially .…”

Section: Discussionmentioning

confidence: 99%

“…In 1991, Gubernatis et al from Hanover, Germany reported the first use of APOLT to treat fulminant hepatic failure (FHF), which affects approximately 50 preadolescent children per year . Since then, several case reports or case series have been published regarding APOLT for FHF, including by our group . One of the greatest advantages of APOLT is the opportunity to withdraw immunosuppression (ISP) entirely in the event of native liver regeneration.…”

Section: Comparison Of Survival and Isp Weaning In Children Older Andmentioning

confidence: 97%

Longterm outcomes of auxiliary partial orthotopic liver transplantation in preadolescent children with fulminant hepatic failure

et al. 2016

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By preserving part of the native liver, auxiliary partial orthotopic liver transplantation (APOLT) provides the advantage of potential immunosuppression (ISP) withdrawal if the native liver recovers but has had limited acceptance, especially in the United States, due to technical complications and low rates of native liver regeneration. No previous study has evaluated APOLT specifically for preadolescent children with fulminant hepatic failure (FHF). This population might benefit especially based on greater capacity for liver regeneration. Data from 13 preadolescent children who underwent APOLT were compared to 13 matched controls who underwent orthotopic liver transplantation (OLT) for FHF from 1996 to 2013. There were no significant differences in patient demographics or survival between the 2 groups. However, all surviving OLT recipients (10/13) remain on ISP, while all but 1 surviving APOLT recipient (12/13) showed native liver regeneration, and the first 10 recipients (76.9%) are currently off ISP with 2 additional patients currently weaning. In our experience, APOLT produced excellent survival and high rates of native liver regeneration in preadolescent children with FHF. This represents the largest series to date to report such outcomes. Liberating these children from lifelong ISP without the downside of increased surgical morbidity makes APOLT an attractive alternative. In conclusion, we therefore propose that, with the availability of technical expertise and with the technical modifications above, APOLT for FHF should be strongly considered for preteenage children with FHF.

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“…Theoretically, this graft may support the patient while the native liver regenerates so that ultimately the patient would not need chronic immunosuppression. Although case reports and small case series have reported success using this technique, the procedure is technically very difficult and has not been adequately evaluated in controlled trials (74).…”

Section: Fulminant Hepatic Failurementioning

confidence: 99%

Advances in critical care management of hepatic failure and insufficiency

Han

Hyzy

2006

Critical Care Medicine

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Auxiliary partial orthotopic liver transplantation in the treatment of acute liver failure: A case report

Cited by 3 publications

References 4 publications

Tuberculosis in liver transplant recipients: A systematic review and meta-analysis of individual patient data

Tuberculosis in liver transplant recipients: A systematic review and meta-analysis of individual patient data

Longterm outcomes of auxiliary partial orthotopic liver transplantation in preadolescent children with fulminant hepatic failure

Advances in critical care management of hepatic failure and insufficiency

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