title: Prolonged anhepatic state after early liver graft removal.
abstract: Two-stage liver transplantation, i.e. salvage emergent total hepatectomy with prolonged anhepatic state, and subsequent liver transplantation, has been described as a life-saving procedure in selected cases. The principal drawback of two-stage liver transplantation is the fact that anhepatic patient survival only depends on the future availability of a liver graft. The pathophysiologic alterations induced by total hepatectomy are not fully known, as it is not known how long a patient may be anhepatic before it is too late for hope of survival. In this report the authors describe the cases of three liver recipients who had to undergo salvage liver graft removal early during or after liver transplantation as a life-saving maneuver. All were afterwards registered for emergent liver retransplantation. Mean anhepatic period was 20 hours (Range: 17-24 hours). Two patients survived and fully recovered. From this experience and from other cases reported in the literature, the authors concluded that total hepatectomy may be life-saving in some cases if a liver graft is available in a timely manner.
authors.affiliation: Department of Liver Transplantation and Surgery, University of Liège, CHU Sart Tilman B35, Liège, Belgium. Oli.Detry@chu.ulg.ac.be
authors.forename: Olivier
authors.initials: O
authors.lastname: Detry
authors.forename: Arnaud
authors.initials: A
authors.lastname: De Roover
authors.forename: Jean
authors.initials: J
authors.lastname: Delwaide
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Hans
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Canivet
authors.forename: Michel
authors.initials: M
authors.lastname: Meurisse
authors.forename: Pierre
authors.initials: P
authors.lastname: Honoré
mesh_terms: D000328:Adult; D003422:Critical Care; D017809:Fatal Outcome; D005260:Female; D006440:Hemofiltration; D006498:Hepatectomy; D006801:Humans; D017114:Liver Failure, Acute / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods / Q000502:physiology; D011167:Portacaval Shunt, Surgical; D012086:Reoperation; D016879:Salvage Therapy; D013997:Time Factors