Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report.
BACKGROUND
Alveolar echinococcosis (AE) of the liver is a rare and severe parasitic disease. It behaves like a slow-growing liver cancer, and liver transplantation (LT) has been proposed in advanced cases since 1985. The aim of this retrospective study was to collect all AE transplant cases in Europe, analyze the results, and specify the usefulness of LT for this unusual indication.


METHODS
A questionnaire was sent to 83 LT centers from July 1996 to December 1999.


RESULTS
Sixty-five centers responded: 45 AE patients (mean age, 45.8 years) underwent an LT procedure at 16 LT centers. The mean interval between diagnosis and LT was 5 years. One patient died during the hepatectomy phase. Five-year survival was 71%. Five-year survival without recurrence was 58%. The nine early deaths were mostly related to bacterial or fungal infections, or both, in patients in bad condition when LT was performed. Six patients had a graft AE reinfection. Five late deaths were related directly to ongoing AE. In the other cases, benzimidazole (BZM) therapy seemed to stabilize AE residues.


CONCLUSIONS
This unique experience indicates that LT is feasible for life-threatening AE. Specific management is needed to optimize the results: earlier decision for LT in incurable symptomatic biliary AE, pre- and post-LT BZM therapy, meticulous pre-LT evaluation to identify extrahepatic extension, and an immunosuppressive regimen kept to a minimum.
Koch
Stéphane
S
Liver Transplant Unit CHU, Besançon, France. skoch@chu-besancon.fr.
Bresson-Hadni
Solange
S
Miguet
Jean-Philippe
JP
Crumbach
Jean-Pierre
JP
Gillet
Michel
M
Mantion
George-André
GA
Heyd
Bruno
B
Vuitton
Dominique-Angèle
DA
Minello
Anne
A
Kurtz
Sabine
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000871:Anthelmintics / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D004444:Echinococcosis, Hepatic / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D005060:Europe; D005260:Female; D006084:Graft Rejection / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis
D000871:Anthelmintics; D001562:Benzimidazoles; D007166:Immunosuppressive Agents; C031000:benzimidazole