Auxiliary partial orthotopic living donor liver transplantation: Kyoto University experience.
Auxiliary partial orthotopic liver transplantation (APOLT) was initially indicated as a potentially reversible fulminant hepatic failure and non-cirrhotic metabolic liver disease to compensate for enzyme deficiency without complete removal of the native liver. We expand our indication of APOLT for small-for-size grafts to support the function of implanted grafts during the early post-operative period, and for ABO-incompatibility to sustain a patient's life if the patient has a graft failure. We retrospectively reviewed 31 patients undergoing APOLT from living donor. The indication of APOLT was fulminant hepatic failure in 6, non-cirrhotic metabolic liver disease in 6, small-for-size grafts in 13 and ABO-incompatible cases in 6. The cumulative survival rate for APOLT at 1 and 5 years was 57.9% and 50.6%, and 78.8% and 73.8% for standard LDLT. None of the patients who underwent transplantation with APOLT for fulminant hepatic failure had long-term patient survival. The incidence of acute cellular rejection was higher in APOLT (58.1%) than standard LDLT (35.0%). Biliary complication was higher and the need for retransplantation was greater in APOLT than standard LDLT (p < 0.01). The results suggest that the indications of APOLT should be reconsidered in view of the risk for complications and retransplantation.
Kasahara
Mureo
M
Organ Transplant Unit, Kyoto University Hospital, Kyoto, Japan. mureo@kuhp.kyoto-u.ac.jp
Takada
Yasutsugu
Y
Egawa
Hiroto
H
Fujimoto
Yasuhiro
Y
Ogura
Yasuhiro
Y
Ogawa
Kohei
K
Kozaki
Koichi
K
Haga
Hironori
H
Ueda
Mikiko
M
Tanaka
Koichi
K
D000017:ABO Blood-Group System; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged
D000017:ABO Blood-Group System