title: Immunosuppression withdrawal after auxiliary liver transplantation for acute liver failure.
abstract: BACKGROUND
  The potential for immunosuppression withdrawal is the rationale for auxiliary liver transplantation (AUX) in patients with acute liver failure (ALF).
  
  
  METHODS
  Forty-four AUX were performed in 28 adults and 16 children with ALF secondary to seronegative hepatitis (n = 20; 45%), paracetamol hepatotoxicity (n = 14; 32%), acute viral hepatitis (hepatitis B virus [HBV] n = 3, Epstein-Barr virus n = 1; 9%), drug-induced hepatitis (n = 3; 7%), autoimmune hepatitis (n = 2; 5%), and mushroom poisoning (n = 1; 2%). All patients fulfilled the King's College Hospital transplant criteria for ALF. After partial hepatectomy, 38 patients received a segmental auxiliary graft and six, a whole auxiliary graft. Immunosuppression was based on calcineurin inhibitors and steroids.
  
  
  RESULTS
  Thirty-four patients (77%) are alive after a median follow-up of 30 months (range 4 to 124). Eight adults and two children died of sepsis (n = 6; 14%) at a median interval of 30 days (range 2 to 66), intraoperative cardiac failure (n = 1), brain edema on postoperative day 8 (n = 1), sudden death on day 35 (n = 1), and multiple organ failure associated with HBV recurrence 4 years after transplantation (n = 1). Three patients underwent retransplantation for small-for-size graft syndrome with sepsis on postoperative day 15 (n = 1) and for ductopenic rejection 4 and 15 months after AUX (n = 2). In 10/31 (32%) survivors (6/18 adults and 4/13 children) immunosuppression was completely withdrawn after a median of 19 months.
  
  
  CONCLUSIONS
  Complete immunosuppression withdrawal can be achieved in a significant proportion of patients after AUX for ALF.
authors.affiliation: Liver Transplant Surgical Service, King's College Hospital, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Girlanda
authors.forename: H
authors.initials: H
authors.lastname: Vilca-Melendez
authors.forename: P
authors.initials: P
authors.lastname: Srinivasan
authors.forename: P
authors.initials: P
authors.lastname: Muiesan
authors.forename: J G
authors.initials: JG
authors.lastname: O'Grady
authors.forename: M
authors.initials: M
authors.lastname: Rela
authors.forename: N D
authors.initials: ND
authors.lastname: Heaton
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis
chemical_list: D007166:Immunosuppressive Agents