title: Hepatic resection after liver transplantation as a graft-saving procedure: indication criteria, timing and outcome.
abstract: BACKGROUND
  Hepatic resection is uncommon after liver transplantation (LT), but can be a graft-saving procedure in selected cases. Herein we describe the criteria, outcome, and timing of this procedure in our series.
  
  
  METHODS
  Between January 1996 and December 2002, 397 LTs were performed in 367 recipients, of whom 12 patients (3.2%) subsequently underwent liver graft resections because of ischemic-type biliary lesions (ITBLs) (n = 5, 41.6%), segmental hepatic artery thrombosis (S-HAT)(n = 3, 25%), recurrent hepatocellular carcinoma (HCC) (n = 2, 16.6%), liver abscess (n = 1, 8.3%), or liver trauma (n = 1, 8.3%). The patients were divided into group 1 (n = 3 all with S-HAT) who underwent early resections (within 3 months of LT), and group 2 (n = 9) who underwent late resections (after 3 months). The outcomes and postoperative mortality ratio (within 30 days) were compared.
  
  
  RESULTS
  The resections consisted of four left lobectomies, three right hepatectomies, two extended right hepatectomies, one segmentectomy, one anterior trisegmentectomy, and one right lateral sectoriectomy. The perioperative mortality rate was 66.6% in group 1 (one case of myocardial infarction and one of sepsis), and 22% in group 2 (one case of sepsis and one of hepatic failure).
  
  
  CONCLUSIONS
  Late resections in stable patients with damage confined to the graft yield good prognosis. Even major resections are feasible graft-saving procedures. In contrast, early hepatic resections in S-HAT are associated with a worse outcome. Retransplantation should be considered the first-choice option. Sepsis significantly affects the postsurgical course.
authors.affiliation: Liver Transplantation Unit, University of Pisa, Pisa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Catalano
authors.forename: L
authors.initials: L
authors.lastname: Urbani
authors.forename: G
authors.initials: G
authors.lastname: Biancofiore
authors.forename: L
authors.initials: L
authors.lastname: Bindi
authors.forename: A
authors.initials: A
authors.lastname: Boldrini
authors.forename: G
authors.initials: G
authors.lastname: Consani
authors.forename: M
authors.initials: M
authors.lastname: Bisà
authors.forename: A
authors.initials: A
authors.lastname: Campatelli
authors.forename: P
authors.initials: P
authors.lastname: Petruzzi
authors.forename: R
authors.initials: R
authors.lastname: Cioni
authors.forename: C
authors.initials: C
authors.lastname: Vignali
authors.forename: F
authors.initials: F
authors.lastname: Mosca
authors.forename: F
authors.initials: F
authors.lastname: Filipponi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000145:classification / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome