title: Ex vivo resection of hepatic neoplasia and autotransplantation: a case report and review of the literature.
abstract: BACKGROUND
  Ex situ liver resection is an uncommon procedure but offers an opportunity for R0 surgical resection of liver tumors that are otherwise unresectable. Liver insufficiency following extensive resections is a risk in this patient population; consequently, all measures should be taken to prevent this highly morbid complication.
  
  
  METHODS
  We report a case of a patient with an extensive cholangiocarcinoma involving all three hepatic veins that required ex vivo resection and liver autotransplantation to achieve an R0 resection. Postoperatively, the patient demonstrated signs of worsening liver function that, in addition to standard medical therapy, underwent a brief treatment with molecular adsorbent recirculating system (MARS) therapy.
  
  
  RESULTS
  Although the role of MARS remains unclear, the patient tolerated it well and her liver graft dysfunction and hepatic encephalopathy slowly resolved. The patient was discharged to a rehabilitation facility. She is currently alive and well with no evidence of recurrence 3 years later.
  
  
  CONCLUSIONS
  We present a review of the literature on ex situ resection and liver autotransplantation. In addition to numerous case reports, there are a few moderate series of ex situ resection and autotransplantation. We suggest that the use of artificial liver devices, if indicated, in the postoperative ex situ resection liver autotransplant patient may assist in the support of the patient while the transplanted liver remnant recovers.
authors.affiliation: Department of Surgery, Division of Transplantation, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, 19107, USA.
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Baker
authors.forename: Warren R
authors.initials: WR
authors.lastname: Maley
authors.forename: Laurence
authors.initials: L
authors.lastname: Needleman
authors.forename: Cataldo
authors.initials: C
authors.lastname: Doria
mesh_terms: D000368:Aged; D018281:Cholangiocarcinoma / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D014182:Transplantation, Autologous
references.citation: Pediatr Transplant. 2000 Nov;4(4):322-7
references.pmid: 11079274
references.citation: J Am Coll Surg. 1999 Nov;189(5):523-6
references.pmid: 10549741
references.citation: Transplant Proc. 2010 Sep;42(7):2625-30
references.pmid: 20832557
references.citation: Transplant Proc. 2012 Sep;44(7):1930-3
references.pmid: 22974875
references.citation: J Gastrointest Surg. 2005 Nov;9(8):1155-61; discussion 1161-2
references.pmid: 16269387
references.citation: Transplant Proc. 2003 Feb;35(1):402-3
references.pmid: 12591460
references.citation: Surgery. 1994 Jun;115(6):740-4
references.pmid: 8197568
references.citation: Liver Transpl. 2008 Jan;14(1):115-7
references.pmid: 18161765
references.citation: Dig Dis Sci. 2013 Dec;58(12):3637-40
references.pmid: 23918151
references.citation: Liver Transpl. 2010 May;16(5):685-7
references.pmid: 20440778
references.citation: Langenbecks Arch Chir. 1988;373(2):122-6
references.pmid: 3287072
references.citation: Surgery. 2000 May;127(5):520-7
references.pmid: 10819060
references.citation: Ann Surg. 2000 Apr;231(4):471-9
references.pmid: 10749606
references.citation: Dig Dis Sci. 2006 Jan;51(1):47-53
references.pmid: 16416211
references.citation: Dig Dis Sci. 2005 Oct;50(10):1829-35
references.pmid: 16187182
references.citation: Transplant Proc. 2009 Jan-Feb;41(1):253-8
references.pmid: 19249528
references.citation: J Pediatr Surg. 2002 Nov;37(11):1640-2
references.pmid: 12407558