title: Emergency subtotal hepatectomy: a new concept for acetaminophen-induced acute liver failure: temporary hepatic support by auxiliary orthotopic liver transplantation enables long-term success.
abstract: BACKGROUND
  Acetaminophen (paracetamol) overdose (AOD) has recently emerged as the leading cause of acute liver failure (ALF) in the United States, with an incidence approaching that seen in the United Kingdom. We describe a new way to treat AOD ALF patients fulfilling King's College criteria for "super-urgent" liver transplantation.
  
  
  METHODS
  Beginning in June 1998, we have been piloting a clinical program of subtotal hepatectomy and auxiliary orthotopic liver transplantation (ALT) for AOD ALF. Our technique is based on the following principles: (1) subtotal hepatectomy; (2) auxiliary transplantation of a whole liver graft; (3) gradual withdrawal of immunosuppression after recovery. Results were compared with patients who had undergone an orthotopic liver transplantation (OLT) for AOD ALF in the same period. Quality of life comparisons were made using the SF36 questionnaire.
  
  
  RESULTS
  Thirteen patients underwent this procedure between June 1998 and March 2005. Median survival is 68 months (range, 0-102 m). Actual survival data show that 9 of 13 patients are alive (69%) compared with 7 of 13 OLT patients (54%). One ALT patient required a retransplantation with an OLT due to hepatic vein thrombosis, and immunosuppression is therefore maintained. The other 8 surviving ALT patients are off immunosuppression. These 8 ALT patients have normal liver function and have a better quality of life compared with the 7 surviving OLT patients.
  
  
  CONCLUSIONS
  Our results with this new technique are encouraging: 69% actual survival, no long-term immunosuppression requirement, and improved quality of life in the 62% successful cases.
authors.affiliation: HPB and Transplant Unit, St James's University Hospital, Leeds, United Kingdom. peterlodge@aol.com
authors.forename: J Peter A
authors.initials: JP
authors.lastname: Lodge
authors.forename: Dowmitra
authors.initials: D
authors.lastname: Dasgupta
authors.forename: K Rajendra
authors.initials: KR
authors.lastname: Prasad
authors.forename: Magdy
authors.initials: M
authors.lastname: Attia
authors.forename: Giles J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: Mervyn
authors.initials: M
authors.lastname: Davies
authors.forename: Charles
authors.initials: C
authors.lastname: Millson
authors.forename: Niall
authors.initials: N
authors.lastname: Breslin
authors.forename: Judith
authors.initials: J
authors.lastname: Wyatt
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Robinson
authors.forename: Mark C
authors.initials: MC
authors.lastname: Bellamy
authors.forename: Nicola
authors.initials: N
authors.lastname: Snook
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Pollard
mesh_terms: D000082:Acetaminophen / Q000506:poisoning*; D000293:Adolescent; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen