title: Long-term follow-up of auxiliary orthotopic liver transplantation for the treatment of fulminant hepatic failure.
abstract: BACKGROUND
  Auxiliary orthotopic liver transplantation (AOLT) was investigated as a bridge to native liver recovery in patients with fulminant hepatic failure (FHF).
  
  
  METHODS
  In the last 5 years seven patients with FHF were treated with AOLT at our institution. Five patients underwent resection of the native left lobe and orthotopic replacement with a donor left lobe (n = 3) or left lateral segment (n = 2). Two patients underwent left trisegmentectomy and whole liver auxiliary grafting. Conventional immunosuppression was used in all patients.
  
  
  RESULTS
  One patient had poor initial graft function and required retransplantation. Native liver function returned to normal in the six other patients. Immunosuppression was gradually tapered and completely discontinued in three patients, allowing for atrophy of the allograft. The allograft was removed in the other four patients. Despite evidence of native liver regeneration, two patients with aplastic anemia died after allograft removal. Four patients are alive at a mean follow-up of 3.5 years.
  
  
  CONCLUSIONS
  AOLT is technically feasible, rapidly restores liver function, and should be considered an important alternative to standard orthotopic liver transplantation (OLT) in the treatment of FHF. AOLT has the advantage that patients transplanted for FHF are not committed to lifelong immunosuppression with its attendant risks.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3285, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Sudan
authors.forename: B W
authors.initials: BW
authors.lastname: Shaw
authors.forename: I J
authors.initials: IJ
authors.lastname: Fox
authors.forename: A N
authors.initials: AN
authors.lastname: Langnas
mesh_terms: D000293:Adolescent; D001663:Bilirubin / Q000097:blood; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods; D006501:Hepatic Encephalopathy / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D011517:Prothrombin Time; D015996:Survival Rate; D013997:Time Factors
chemical_list: D001663:Bilirubin