Faculty Collaboration Database

Subtotal hepatectomy and whole graft auxiliary transplantation for acetaminophen-associated acute liver failure. HPB (Oxford) 2014 Mar;16(3):220-8

Date

07/23/2013

Pubmed ID

23870048

Pubmed Central ID

PMC3945847

DOI

10.1111/hpb.12124

Scopus ID

2-s2.0-84894483333 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

BACKGROUND: An acetominophen overdose (AOD) is the leading cause of acute liver failure (ALF) in the UK and USA. For patients who meet the King's College Hospital criteria, (mortality risk > 85%), an emergency orthotopic liver transplantation (OLT) is conventionally performed with subsequent life-long immunosuppression. A new technique was developed in 1998 for AOD-induced ALF where a subtotal hepatectomy (right hepatic trisectionectomy) and whole graft auxiliary liver transplant (WGALT) was performed with complete withdrawal of immunosupression during the first year post-operatively.

RESULTS: During 1998-2010, 68 patients were listed for an emergency transplantation for AOD ALF at our institution: 28 died waiting, 16 underwent OLT and 24 a subtotal hepatectomy with WGALT. Eight OLT (50%) and 16 WGALT remain alive (67%); actuarial survival at 5 years OLT 50%, WGALT 63%, P = 0.37. All patients who had successful WGALT are off immunosuppression. Poor prognostic factors in the WGALT group included higher donor age (40.4 versus 53.9, P = 0.043), requirements for a blood transfusion (4.3 versus 7.6, P = 0.0043) and recipient weight (63.1 versus 54 kg, P = 0.036).

CONCLUSION: Although OLT remains standard practice for AOD-induced ALF, life-long immunosuppression is required. A favourable survival rate using a subtotal hepatectomy and WGALT has been demonstrated, and importantly, all successful patients have undergone complete immunosuppression withdrawal. This technique is advocated for patients who have acetominophen hepatotoxicity requiring liver transplantation.

Author List

Rajput I, Prasad KR, Bellamy MC, Davies M, Attia MS, Lodge JP

Author

Kondragunta Rajendra Prasad MBBS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acetaminophen
Adolescent
Adult
Analgesics, Non-Narcotic
Chemical and Drug Induced Liver Injury
Drug Overdose
Emergencies
Female
Hepatectomy
Humans
Immunosuppressive Agents
Kaplan-Meier Estimate
Liver Failure, Acute
Liver Regeneration
Liver Transplantation
Male
Middle Aged
Risk Factors
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Waiting Lists
Young Adult