Revisiting APOLT for Metabolic Liver Disease: A New Look at an Old Idea.
Even though auxiliary partial orthotopic liver transplantation (APOLT) as a technique was popularized in the late 80s, its role in metabolic liver disease remains controversial. The slow progress in gene therapy research, high incidence of technical complications, and the problem of long term graft atrophy have been roadblocks to its wider application. Better understanding of reciprocal dynamics of portal flow and regeneration between the graft and native liver along with multiple refinements in surgical technique have improved the outcomes of this operation, making it a safe alternative to orthotopic liver transplantation for patients with a wide range of noncirrhotic metabolic liver diseases (NCMLD). The ability to perform APOLT safely has also opened up a range of exciting indications in the setting of NCMLD. This article reviews the current status of APOLT for NCMLD, technical refinements which have improved outcomes and novel indications, which have rekindled fresh interest in this procedure.
1 Institute of Liver Disease and Transplantation, Global Health City, Chennai, India. 2 Institute of Liver Studies, Kings College Hospital, London, United Kingdom.
Mettu Srinivas
MS
Reddy
Rajesh
R
Rajalingam
Mohamed
M
Rela
D000818:Animals; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D008099:Liver / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008107:Liver Diseases / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008659:Metabolic Diseases / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents