title: Total hepatectomy and liver transplantation as a two-stage procedure for fulminant hepatic failure: A safe procedure in exceptional circumstances.
abstract: OBJECTIVE
  To evaluate the outcomes of two-stage liver transplant at a single institution, between 1993 and March 2015.
  
  
  METHODS
  We reviewed our institutional experience with emergency hepatectomy followed by transplantation for fulminant liver failure over a twenty-year period. A retrospective review of a prospectively maintained liver transplant database was undertaken at a national liver transplant centre. Demographic data, clinical presentation, preoperative investigations, cardiocirculatory parameters, operative and postoperative data were recorded.
  
  
  RESULTS
  In the study period, six two-stage liver transplants were undertaken. Indications for transplantation included acute paracetamol poisoning (n = 3), fulminant hepatitis A (n = 1), trauma (n = 1) and exertional heat stroke (n = 1). Anhepatic time ranged from 330 to 2640 min. All patients demonstrated systemic inflammatory response syndrome in the first post-operative week and the incidence of sepsis was high at 50%. There was one mortality, secondary to cardiac arrest 12 h following re-perfusion. Two patients required re-transplantation secondary to arterial thrombosis. At a median follow-up of 112 mo, 5 of 6 patients are alive and without evidence of graft dysfunciton.
  
  
  CONCLUSIONS
  Two-stage liver transplantation represents a safe and potentially life-saving treatment for carefully selected exceptional cases of fulminant hepatic failure.
authors: Rebeca Sanabria Mateos, Niamh M Hogan, Dimitri Dorcaratto, Helen Heneghan, Venkatesh Udupa, Donal Maguire, Justin Geoghegan, Emir Hoti, Hepatobiliary and Liver Transplant Surgical Unit, St. Vincent's University Hospital, Dublin 4, Ireland.
authors: Rebeca
authors: R
authors: Sanabria Mateos
authors: Rebeca Sanabria Mateos, Niamh M Hogan, Dimitri Dorcaratto, Helen Heneghan, Venkatesh Udupa, Donal Maguire, Justin Geoghegan, Emir Hoti, Hepatobiliary and Liver Transplant Surgical Unit, St. Vincent's University Hospital, Dublin 4, Ireland.
authors: Niamh M
authors: NM
authors: Hogan
authors: Rebeca Sanabria Mateos, Niamh M Hogan, Dimitri Dorcaratto, Helen Heneghan, Venkatesh Udupa, Donal Maguire, Justin Geoghegan, Emir Hoti, Hepatobiliary and Liver Transplant Surgical Unit, St. Vincent's University Hospital, Dublin 4, Ireland.
authors: Dimitri
authors: D
authors: Dorcaratto
authors: Rebeca Sanabria Mateos, Niamh M Hogan, Dimitri Dorcaratto, Helen Heneghan, Venkatesh Udupa, Donal Maguire, Justin Geoghegan, Emir Hoti, Hepatobiliary and Liver Transplant Surgical Unit, St. Vincent's University Hospital, Dublin 4, Ireland.
authors: Helen
authors: H
authors: Heneghan
authors: Rebeca Sanabria Mateos, Niamh M Hogan, Dimitri Dorcaratto, Helen Heneghan, Venkatesh Udupa, Donal Maguire, Justin Geoghegan, Emir Hoti, Hepatobiliary and Liver Transplant Surgical Unit, St. Vincent's University Hospital, Dublin 4, Ireland.
authors: Venkatesh
authors: V
authors: Udupa
authors: Rebeca Sanabria Mateos, Niamh M Hogan, Dimitri Dorcaratto, Helen Heneghan, Venkatesh Udupa, Donal Maguire, Justin Geoghegan, Emir Hoti, Hepatobiliary and Liver Transplant Surgical Unit, St. Vincent's University Hospital, Dublin 4, Ireland.
authors: Donal
authors: D
authors: Maguire
authors: Rebeca Sanabria Mateos, Niamh M Hogan, Dimitri Dorcaratto, Helen Heneghan, Venkatesh Udupa, Donal Maguire, Justin Geoghegan, Emir Hoti, Hepatobiliary and Liver Transplant Surgical Unit, St. Vincent's University Hospital, Dublin 4, Ireland.
authors: Justin
authors: J
authors: Geoghegan
authors: Rebeca Sanabria Mateos, Niamh M Hogan, Dimitri Dorcaratto, Helen Heneghan, Venkatesh Udupa, Donal Maguire, Justin Geoghegan, Emir Hoti, Hepatobiliary and Liver Transplant Surgical Unit, St. Vincent's University Hospital, Dublin 4, Ireland.
authors: Emir
authors: E
authors: Hoti
keywords: Fulminant hepatic failure; Liver transplant; Survival; Two-stage liver transplantation