title: Ex Vivo Liver Resection and Autotransplantation for End-Stage Alveolar Echinococcosis: A Case Series.
abstract: The role of autotransplantation in end-stage hepatic alveolar echinococcosis (AE) is unclear. We aimed to present our 15-case experience and propose selection criteria for autotransplantation. All patients were considered to have unresectable hepatic AE by conventional resection due to critical invasion to retrohepatic vena cava, hepatocaval region along with three hepatic veins, and the tertiary portal and arterial branches. All patients successfully underwent ex vivo extended right hepatectomy and autotransplantation without intraoperative mortality. The median autograft weight was 706 g (380-1000 g); operative time was 15.5 hours (11.5-20.5 hours); and anhepatic time was 283.8 minutes (180-435 min). Postoperative hospital stay was 32.3 days (12-60 days). Postoperative complication Clavien-Dindo grade IIIa or higher occurred in three patients including one death that occurred 12 days after the surgery due to acute liver failure. One patient was lost to follow-up after the sixth month. Thirteen patients were followed for a median of 21.6 months with no relapse. This is the largest reported series of patients with end-stage hepatic AE treated with liver autotransplantation. The technique requires neither organ donor nor postoperative immunosuppressant. The early postoperative mortality was low with acceptable morbidity. Preoperative precise assessment and strict patient selection are of utmost importance.
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, P.R. China.
authors.forename: H
authors.initials: H
authors.lastname: Wen
authors.affiliation: Department of Hepatobiliary Surgery, Beijing Tsinghua Chang Gung Hospital, Beijing, P.R. China.
authors.forename: J-H
authors.initials: JH
authors.lastname: Dong
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, P.R. China.
authors.forename: J-H
authors.initials: JH
authors.lastname: Zhang
authors.affiliation: Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, P.R. China.
authors.forename: W-D
authors.initials: WD
authors.lastname: Duan
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, P.R. China.
authors.forename: J-M
authors.initials: JM
authors.lastname: Zhao
authors.affiliation: Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, P.R. China.
authors.forename: Y-R
authors.initials: YR
authors.lastname: Liang
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, P.R. China.
authors.forename: Y-M
authors.initials: YM
authors.lastname: Shao
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, P.R. China.
authors.forename: X-W
authors.initials: XW
authors.lastname: Ji
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, P.R. China.
authors.forename: Q-W
authors.initials: QW
authors.lastname: Tai
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, P.R. China.
authors.forename: T
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, P.R. China.
authors.forename: H
authors.initials: H
authors.lastname: Gu
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, P.R. China.
authors.forename: T
authors.initials: T
authors.lastname: Tuxun
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, P.R. China.
authors.forename: Y-B
authors.initials: YB
authors.lastname: He
authors.affiliation: Department of Hepatobiliary Surgery, Peking Union Medical College Hospital, Beijing, P.R. China.
authors.forename: J-F
authors.initials: JF
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D004444:Echinococcosis, Hepatic / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006498:Hepatectomy; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D014182:Transplantation, Autologous; D014682:Vena Cava, Inferior / Q000601:surgery*; D055815:Young Adult
keywords: clinical research/practice; liver disease: infectious, liver disease, liver transplantation: living donor; liver transplantation/hepatology