Auxilliary Liver Transplantation According to the RAPID Procedure in Noncirrhotic Patients

Abstract

Objective: To present technical details and short-term experiences of liver transplantation as a 2-stage procedure using small for size grafts in a multicenter cohort study. Background: Two-stage liver transplantation using small for size grafts should be a feasible procedure with lower morbidity and mortality rates. Retrospective cohort study between 2015 and 2022 with multicenter experience. Twenty-three resection and partial liver transplantation with delayed total hepatectomy procedures for noncirrhotic indications were performed in 6 European centers (20 with grafts from living donors and 3 after deceased donation). Procedure’s feasibility, graft volumetric changes, morbidity, and mortality of donor and recipient were explored. Results: There was a low donor morbidity (4.3%) in our cohort. Hypertrophy of the graft was rapid (mean graft volume increases 107% between both stages) and offered the opportunity for remnant hepatectomy after a median of 14 days. In all cases, portomesenteric flow was routed to the graft by right remnant portal vein ligation. Portal vein inflow modulation to alleviate transient harmful portal hypertension was not needed in any case. Early postoperative mortality (4.3%) of the recipients were low. Ten patients suffered from complications ≥IIIb according to the Clavien-Dindo classification. Conclusions: Two-stage liver transplantation is a feasible option for noncirrhotic patients allowing the safe use of small for size grafts and could possibly be extended with caution to liver diseases with portal hypertension and cirrhosis. The resection and partial liver transplantation with delayed total hepatectomy technique might be a viable option for expanding the donor pool given the current organ shortage especially for low–model of end stage liver disease patients.

Long-Term Survival, Prognostic Factors, and Selection of Patients With Colorectal Cancer for Liver Transplant

“…Within 3 weeks, the donor segments have increased to sufficient size to avoid liver failure, and resection of segments 4 to 8 is performed . This opens the possibility for a donor graft offering a life extension for 2 patients or for use as a living donor with low risk for the donor …”

“…34 This opens the possibility for a donor graft offering a life extension for 2 patients or for use as a living donor with low risk for the donor. 35,36…”

Resection Details, Donor Segment Volume, and Adjuvant Chemotherapy in Patients With Colorectal Cancer and Liver Transplant—Reply

“…Chen and Wei question whether 3 weeks between the first-stage transplant and second-stage liver remnant hepatectomy was sufficient time for donor graft survival without liver failure for the recipients. The 1-year outcomes of 22 RAPID operations from 7 European centers have been published, and no signs of posthepatectomy liver failure was observed after an median interval of 14 days . In our own experience, the donor grafts increased in volume by 110% to 183%, resulting in a ratio of graft to recipient body weight of 0.75% to 0.97%.…”

The development of Transplant Oncology may worsen the liver gap and needs new technical options in liver transplantation

“…At stage 2, a minimally invasive method may be performed. 12 Obviously, as previously demonstrated in patients with uCRLM, rigorous recipient selection is required.…”