Temporary heterotopic auxiliary liver transplantation for fulminant hepatitis B.
OBJECTIVE
Orthotopic liver transplantation has been shown to improve survival in fulminant hepatic failure. However, after orthotopic liver transplantation life-long immunosuppression is necessary and graft complications may occur.


METHODS
We employed heterotopic auxiliary liver transplantation in a 26-year-old man with fulminant hepatic failure due to hepatitis B virus infection.


RESULTS
From a comatose state with seizures and decerebrate posturing, the patient woke up the day after heterotopic auxiliary liver transplantation. The graft functioned sufficiently. After 2 weeks, when peritonitis developed, immunosuppression was stopped since the native liver was recovering as shown by serial HIDA scans, liver biopsies, clotting parameters and serum bilirubin. When severe rejection of the graft developed 2 weeks later, and the peritonitis had been treated successfully, the native liver had recovered sufficiently to allow the graft to be removed. Now, more than 1 year after heterotopic auxiliary liver transplantation, the patient is free from medication and he is immune for hepatitis B virus, his liver tests have returned to normal and he has regained his normal life.


CONCLUSIONS
Temporary heterotopic auxiliary liver transplantation for fulminant hepatitis B is feasible.
D000208:Acute Disease; D000328:Adult; D001663:Bilirubin / Q000097:blood; D001706:Biopsy; D004279:DNA, Viral / Q000032:analysis; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000601:surgery*; D006509:Hepatitis B / Q000097:blood / Q000150:complications*; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation; D008297:Male; D016133:Polymerase Chain Reaction; D014183:Transplantation, Heterologous
D004279:DNA, Viral; D007166:Immunosuppressive Agents; D001663:Bilirubin