Faculty Collaboration Database

Emergency subtotal hepatectomy: a new concept for acetaminophen-induced acute liver failure: temporary hepatic support by auxiliary orthotopic liver transplantation enables long-term success. Ann Surg 2008 Feb;247(2):238-49

Date

01/25/2008

Pubmed ID

18216528

DOI

10.1097/SLA.0b013e31816401ec

Scopus ID

2-s2.0-38549110509 (requires institutional sign-in at Scopus site)   37 Citations

Abstract

INTRODUCTION: Acetaminophen (paracetamol) overdose (AOD) has recently emerged as the leading cause of acute liver failure (ALF) in the United States, with an incidence approaching that seen in the United Kingdom. We describe a new way to treat AOD ALF patients fulfilling King's College criteria for "super-urgent" liver transplantation.

METHODS: Beginning in June 1998, we have been piloting a clinical program of subtotal hepatectomy and auxiliary orthotopic liver transplantation (ALT) for AOD ALF. Our technique is based on the following principles: (1) subtotal hepatectomy; (2) auxiliary transplantation of a whole liver graft; (3) gradual withdrawal of immunosuppression after recovery. Results were compared with patients who had undergone an orthotopic liver transplantation (OLT) for AOD ALF in the same period. Quality of life comparisons were made using the SF36 questionnaire.

RESULTS: Thirteen patients underwent this procedure between June 1998 and March 2005. Median survival is 68 months (range, 0-102 m). Actual survival data show that 9 of 13 patients are alive (69%) compared with 7 of 13 OLT patients (54%). One ALT patient required a retransplantation with an OLT due to hepatic vein thrombosis, and immunosuppression is therefore maintained. The other 8 surviving ALT patients are off immunosuppression. These 8 ALT patients have normal liver function and have a better quality of life compared with the 7 surviving OLT patients.

CONCLUSION: Our results with this new technique are encouraging: 69% actual survival, no long-term immunosuppression requirement, and improved quality of life in the 62% successful cases.

Author List

Lodge JP, Dasgupta D, Prasad KR, Attia M, Toogood GJ, Davies M, Millson C, Breslin N, Wyatt J, Robinson PJ, Bellamy MC, Snook N, Pollard SG

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
Female
Follow-Up Studies
Hepatectomy
Humans
Liver Failure, Acute
Liver Transplantation
Male
Middle Aged
Pilot Projects
Quality of Life
Retrospective Studies
Survival Rate
Time Factors
Treatment Outcome