Liver resection in liver transplant recipients.
BACKGROUND
Liver resection after liver transplantation is a relatively uncommon procedure. Indications for liver resection include hepatic artery thrombosis (HAT), non-anastomotic biliary stricture (ischemic biliary lesions), liver abscess, liver trauma and recurrence of hepatocellular carcinoma (HCC). Organ shortage and lower survival after re-transplantation have encouraged us to make attempts at graft salvage.


METHODS
Eleven resections at a mean of 59 months after liver transplantation were made over 18 years. Indications for liver resection included HCC recurrence in 4 patients, ischemic cholangiopathy, segmental HAT, sepsis and infected hematoma in 2 each, and ischemic segment IV after split liver transplantation in 1.


RESULTS
There was no perioperative mortality. Morbidity included one re-laparotomy for small bowel perforation, one bile leak treated conservatively, one right subphrenic collection, one wound infection and 5 episodes of Gram-negative sepsis. One patient underwent re-transplantation 4 months after resection for chronic rejection. There were 3 deaths, two from HCC recurrence and one from post-transplant lymphoproliferative disorder. The overall mean follow-up after resection was 48 months.


CONCLUSIONS
Liver resection in liver transplant recipients is safe, and has good outcome in selected patients and avoids re-transplantation in the majority of patients. Recipients with recurrent HCC in graft may benefit from resection, but cure is uncommon.
Marangoni
Gabriele
G
King's College London School of Medicine at King's College Hospital, Institute of Liver Studies, Denmark Hill, SE59RS London, UK.
Faraj
Walid
W
Sethi
Harsheet
H
Rela
Mohamed
M
Muiesan
Paolo
P
Heaton
Nigel
N
D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002779:Cholestasis / Q000401:mortality / Q000601:surgery; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality* / Q000601:surgery*; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D013927:Thrombosis / Q000401:mortality / Q000601:surgery