Current status of auxiliary partial orthotopic liver transplantation for acute liver failure

Abstract

Auxiliary partial orthotopic liver transplantation (APOLT) is a technique of liver transplantation (LT) where a partial liver graft is implanted in an orthotopic position after leaving behind a part of the native liver. APOLT was previously considered technically challenging with results inferior to orthotopic liver transplantation. Results of this procedure have continued to improve with improving surgical techniques and a better understanding of the natural history of acute liver failure (ALF) and liver regeneration. The procedure is being increasingly accepted as a valid treatment option for ALF-especially in children. This article reviews the historical background to this operation, advances in the technique, and its current place in the management of ALF. Liver Transplantation 22 1265-1274 2016 AASLD.

Liver transplantation in children: state of the art and future perspectives

“…It has been reported in different European multicentre studies that children and young adults under the age of 40 years old showed higher ability to regenerate their native liver compared with 75% risk of developing fibrosis in those recipients over this age 14 23. Another favourable factor for regeneration described in these studies was the hyperacute presentation of the liver failure compared with those with more than 1 week from jaundice to encephalopathy,14 as well as the aetiology of the hyperacute ALF such as acetaminophen, hepatitis B and E, and mushroom poisoning 26. Acetaminophen-induced liver failure remains an important cause of ALF in UK and the USA 28.…”

Auxiliary Liver Transplantation as a Transient Treatment for Acute Liver Failure: Two Cases

“…Generally, immunosuppression can be gradually weaned off after confirmation of NLR, resulting in progressive atrophy of the implant [3,9]. However, in these two cases, regardless of the hypothetic atrophy of the auxiliary liver, the decision to remove the graft was appropriate.…”

“…Nevertheless, if the vital liver functions are preserved during a given period, NLR can occur in a particular number of patients. The growing rate of ALT adoption worldwide shows that this approach can be a good alternative treatment for ALF [3].…”

“…While this procedure has the advantage of avoiding a hepatectomy in the recipient, issues such as graft congestion, caused by compromised graft hepatic outflow, may cause complications [7]. In the last 2-3 decades, partial ALT has gained recognition [3]. However, there is no consensus regarding appropriate graft placement.…”

“…While liver transplantation is often the only curative treatment, it is only performed in 18% of cases [2]. Auxiliary liver transplantation (ALT) has emerged as a valuable alternative to orthotopic liver transplantation in the ALF setting [3,4]. The graft allows liver function support during the period of native organ failure, giving the necessary time frame to the injured liver to regenerate.…”