title: Subtotal hepatectomy and whole graft auxiliary transplantation for acetaminophen-associated acute liver failure.
abstract: BACKGROUND
  An acetominophen overdose (AOD) is the leading cause of acute liver failure (ALF) in the UK and USA. For patients who meet the King's College Hospital criteria, (mortality risk > 85%), an emergency orthotopic liver transplantation (OLT) is conventionally performed with subsequent life-long immunosuppression. A new technique was developed in 1998 for AOD-induced ALF where a subtotal hepatectomy (right hepatic trisectionectomy) and whole graft auxiliary liver transplant (WGALT) was performed with complete withdrawal of immunosupression during the first year post-operatively.
  
  
  RESULTS
  During 1998-2010, 68 patients were listed for an emergency transplantation for AOD ALF at our institution: 28 died waiting, 16 underwent OLT and 24 a subtotal hepatectomy with WGALT. Eight OLT (50%) and 16 WGALT remain alive (67%); actuarial survival at 5 years OLT 50%, WGALT 63%, P = 0.37. All patients who had successful WGALT are off immunosuppression. Poor prognostic factors in the WGALT group included higher donor age (40.4 versus 53.9, P = 0.043), requirements for a blood transfusion (4.3 versus 7.6, P = 0.0043) and recipient weight (63.1 versus 54 kg, P = 0.036).
  
  
  CONCLUSIONS
  Although OLT remains standard practice for AOD-induced ALF, life-long immunosuppression is required. A favourable survival rate using a subtotal hepatectomy and WGALT has been demonstrated, and importantly, all successful patients have undergone complete immunosuppression withdrawal. This technique is advocated for patients who have acetominophen hepatotoxicity requiring liver transplantation.
authors.affiliation: HPB and Transplant Unit, St. James's University Hospital, Leeds, UK.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Rajput
authors.forename: K Rajendra
authors.initials: KR
authors.lastname: Prasad
authors.forename: Mark C
authors.initials: MC
authors.lastname: Bellamy
authors.forename: Mervyn
authors.initials: M
authors.lastname: Davies
authors.forename: Magdy S
authors.initials: MS
authors.lastname: Attia
authors.forename: J Peter A
authors.initials: JP
authors.lastname: Lodge
mesh_terms: D000082:Acetaminophen / Q000506:poisoning*; D000293:Adolescent; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D062787:Drug Overdose; D004630:Emergencies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D017114:Liver Failure, Acute / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D007166:Immunosuppressive Agents; D000082:Acetaminophen