title: Longterm outcomes of auxiliary partial orthotopic liver transplantation in preadolescent children with fulminant hepatic failure.
abstract: By preserving part of the native liver, auxiliary partial orthotopic liver transplantation (APOLT) provides the advantage of potential immunosuppression (ISP) withdrawal if the native liver recovers but has had limited acceptance, especially in the United States, due to technical complications and low rates of native liver regeneration. No previous study has evaluated APOLT specifically for preadolescent children with fulminant hepatic failure (FHF). This population might benefit especially based on greater capacity for liver regeneration. Data from 13 preadolescent children who underwent APOLT were compared to 13 matched controls who underwent orthotopic liver transplantation (OLT) for FHF from 1996 to 2013. There were no significant differences in patient demographics or survival between the 2 groups. However, all surviving OLT recipients (10/13) remain on ISP, while all but 1 surviving APOLT recipient (12/13) showed native liver regeneration, and the first 10 recipients (76.9%) are currently off ISP with 2 additional patients currently weaning. In our experience, APOLT produced excellent survival and high rates of native liver regeneration in preadolescent children with FHF. This represents the largest series to date to report such outcomes. Liberating these children from lifelong ISP without the downside of increased surgical morbidity makes APOLT an attractive alternative. In conclusion, we therefore propose that, with the availability of technical expertise and with the technical modifications above, APOLT for FHF should be strongly considered for preteenage children with FHF.
authors.affiliation: Center for Liver Disease and Transplantation, New York Presbyterian-Columbia University Medical Center, New York, NY.
authors.forename: Joshua
authors.initials: J
authors.lastname: Weiner
authors.affiliation: Center for Liver Disease and Transplantation, New York Presbyterian-Columbia University Medical Center, New York, NY.
authors.forename: Adam
authors.initials: A
authors.lastname: Griesemer
authors.affiliation: Division of Transplant Surgery, MedStar Georgetown University Hospital, Washington, DC.
authors.forename: Eddie
authors.initials: E
authors.lastname: Island
authors.affiliation: Center for Liver Disease and Transplantation, New York Presbyterian-Columbia University Medical Center, New York, NY.
authors.forename: Steven
authors.initials: S
authors.lastname: Lobritto
authors.affiliation: Center for Liver Disease and Transplantation, New York Presbyterian-Columbia University Medical Center, New York, NY.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Martinez
authors.affiliation: Miami Transplant Institute, University of Miami Health System, Miami, FL.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Selvaggi
authors.affiliation: Center for Liver Disease and Transplantation, New York Presbyterian-Columbia University Medical Center, New York, NY.
authors.forename: Jay
authors.initials: J
authors.lastname: Lefkowitch
authors.affiliation: Center for Liver Disease and Transplantation, New York Presbyterian-Columbia University Medical Center, New York, NY.
authors.forename: Monica
authors.initials: M
authors.lastname: Velasco
authors.affiliation: Miami Transplant Institute, University of Miami Health System, Miami, FL.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tryphonopoulos
authors.affiliation: Center for Liver Disease and Transplantation, New York Presbyterian-Columbia University Medical Center, New York, NY.
authors.forename: Jean
authors.initials: J
authors.lastname: Emond
authors.affiliation: Department of General and Vascular Surgery, Cleveland Clinic Florida, Weston, FL.
authors.forename: Andreas
authors.initials: A
authors.lastname: Tzakis
authors.affiliation: Center for Liver Disease and Transplantation, New York Presbyterian-Columbia University Medical Center, New York, NY.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kato
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy / Q000706:statistics & numerical data*; D007223:Infant; D008099:Liver / Q000473:pathology / Q000502:physiology*; D017114:Liver Failure, Acute / Q000401:mortality / Q000601:surgery*; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult