Refining Auxiliary Orthotopic Liver Transplantation (AOLT) Improves Outcomes in Adult Patients With Acute Liver Failure.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 11 2023
01 11 2023
Historique:
medline:
23
10
2023
pubmed:
20
7
2023
entrez:
20
7
2023
Statut:
ppublish
Résumé
To investigate whether and how experience accumulation and technical refinements simultaneously implemented in auxiliary orthotopic liver transplantation (AOLT) may impact on outcomes. AOLT for acute liver failure (ALF) provides the unique chance of complete immunosuppression withdrawal after adequate native liver remnant regeneration but is a technically demanding procedure. Our department is a reference center for ALF and an early adopter of AOLT. This is a single-center retrospective before/after study of a prospectively maintained cohort of 48 patients with ALF who underwent AOLT between 1993 and 2019. In 2012, technical refinements were implemented to improve outcomes: (i) favoring the volume of the graft rather than that of the native liver, (ii) direct anastomosis of graft hepatic artery with recipient right hepatic artery instead of the use of large size vessels, (iii) end-to-side hepaticocholedocostomy instead of bilioenteric anastomosis. Early experience (1993-2011) group (n=26) and recent experience (2012-2019) group (n=22) were compared. Primary endpoint was 90-day severe morbidity rate (Clavien-Dindo≥IIIa) and secondary endpoints were overall patient survival and complete immunosuppression withdrawal rates. Compared with the earlier experience group, the recent experience group was associated with a lower severe complication rate (27% vs 65%, P <0.001), as well as less biliary (18% vs 54%, P =0.017) and arterial (0% vs 15%, P =0.115) complications. The 1-, 3-, and 5-year patient survival was significantly improved (91%, 91%, 91% vs 76%, 61%, 60%, P =0.045). The rate of complete immunosuppression withdrawal increased to 94% vs 70%, ( P =0.091) with no need of long-term graft explant. These technical refinements favoring the liver graft and reducing morbidity may promote AOLT implementation among LT centers.
Sections du résumé
OBJECTIVE
To investigate whether and how experience accumulation and technical refinements simultaneously implemented in auxiliary orthotopic liver transplantation (AOLT) may impact on outcomes.
BACKGROUND
AOLT for acute liver failure (ALF) provides the unique chance of complete immunosuppression withdrawal after adequate native liver remnant regeneration but is a technically demanding procedure. Our department is a reference center for ALF and an early adopter of AOLT.
METHODS
This is a single-center retrospective before/after study of a prospectively maintained cohort of 48 patients with ALF who underwent AOLT between 1993 and 2019. In 2012, technical refinements were implemented to improve outcomes: (i) favoring the volume of the graft rather than that of the native liver, (ii) direct anastomosis of graft hepatic artery with recipient right hepatic artery instead of the use of large size vessels, (iii) end-to-side hepaticocholedocostomy instead of bilioenteric anastomosis. Early experience (1993-2011) group (n=26) and recent experience (2012-2019) group (n=22) were compared. Primary endpoint was 90-day severe morbidity rate (Clavien-Dindo≥IIIa) and secondary endpoints were overall patient survival and complete immunosuppression withdrawal rates.
RESULTS
Compared with the earlier experience group, the recent experience group was associated with a lower severe complication rate (27% vs 65%, P <0.001), as well as less biliary (18% vs 54%, P =0.017) and arterial (0% vs 15%, P =0.115) complications. The 1-, 3-, and 5-year patient survival was significantly improved (91%, 91%, 91% vs 76%, 61%, 60%, P =0.045). The rate of complete immunosuppression withdrawal increased to 94% vs 70%, ( P =0.091) with no need of long-term graft explant.
CONCLUSION
These technical refinements favoring the liver graft and reducing morbidity may promote AOLT implementation among LT centers.
Identifiants
pubmed: 37470188
doi: 10.1097/SLA.0000000000006019
pii: 00000658-202311000-00021
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
790-797Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
European Association for the Study of the Liver. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017;66:1047–1081.
Kumar R, Anand U, Priyadarshi RN. Liver transplantation in acute liver failure: dilemmas and challenges. World J Transplant. 2021;11:187–202.
Olivo R, Guarrera JV, Pyrsopoulos NT. Liver transplantation for acute liver failure. Clin Liver Dis. 2018;22:409–417.
Stravitz RT, Lee WM. Acute liver failure. Lancet. 2019;394:869–881.
Mendizabal M, Silva MO. Liver transplantation in acute liver failure: a challenging scenario. World J Gastroenterol. 2016;22:1523–1531.
Rela M, Kaliamoorthy I, Reddy MS. Current status of auxiliary partial orthotopic liver transplantation for acute liver failure. Liver Transpl. 2016;22:1265–1274.
Belghiti J, Sommacale D, Dondéro F, et al. Auxiliary liver transplantation for acute liver failure. HPB (Oxford). 2004;6:83.
Jaeck D, Boudjema K, Audet M, et al. Auxiliary partial orthotopic liver transplantation (APOLT) in the treatment of acute liver failure. J Gastroenterol. 2002;37(suppl 13):88–91.
Chenard-Neu MP, Boudjema K, Bernuau J, et al. Auxiliary liver transplantation: regeneration of the native liver and outcome in 30 patients with fulminant hepatic failure—a multicenter European study. Hepatology. 1996;23:1119–1127.
Quaglia A, Portmann BC, Knisely AS, et al. Auxiliary transplantation for acute liver failure: histopathological study of native liver regeneration. Liver Transpl. 2008;14:1437–1448.
Azoulay D, Samuel D, Ichai P, et al. Auxiliary partial orthotopic versus standard orthotopic whole liver transplantation for acute liver failure: a reappraisal from a single center by a case-control study. Ann Surg. 2001;234:723–731.
Rajput I, Prasad KR, Bellamy MC, et al. Subtotal hepatectomy and whole graft auxiliary transplantation for acetaminophen-associated acute liver failure. HPB (Oxford). 2014;16:220–228.
Weiner J, Griesemer A, Island E, et al. Long-term outcomes of auxiliary partial orthotopic liver transplantation in preadolescent children with fulminant hepatic failure. Liver Transpl. 2016;22:485–494.
Bernuau J, Samuel D, Durand F, et al. Criteria for emergency liver transplantation in patients with acute viral hepatitis and factor V below 50% of normal: a prospective study. Hepatology. 1991;14:49A.
O’Grady JG, Alexander GJ, Hayllar KM, et al. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97:439–445.
Escudié L, Francoz C, Vinel JP, et al. Amanita phalloides poisoning: reassessment of prognostic factors and indications for emergency liver transplantation. J Hepatol. 2007;46:466–473.
Pravisani R, Sepulveda A, Cocchi L, et al. Graft aberrant hepatic arteries in deceased donor liver transplantation: The “one liver, one artery” approach. Liver Transpl. 2022;28:1876–1887.
Nagino M, DeMatteo R, Lang H, et al. Proposal of a new comprehensive notation for hepatectomy: the “New World” terminology. Ann Surg. 2021;274:1–3.
Lodge JP, Dasgupta D, Prasad KR, et al. 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;247:238–249.
Vivarelli M, Benedetti Cacciaguerra A, Lerut J, et al. Infrarenal versus supraceliacaorto-hepatic arterial revascularisation in adult liver transplantation: multicentre retrospective study. Updates Surg. 2020;72:659–669.
Reese T, Raptis DA, Oberkofler CE, et al. A systematic review and meta-analysis of rescue revascularization with arterial conduits in liver transplantation. Am J Transplant. 2019;19:551–563.
Le Roy B, Cauchy F, Cesaretti M, et al. Further to the right: Piggyback anastomosis on the right hepatic vein facilitates the implantation of small liver grafts (the one-vein technique). Ann Surg. 2019;269:e60–e62.
Muller X, Marcon F, Sapisochin G, et al. Defining benchmarks in liver transplantation: a multicenter outcome analysis determining best achievable results. Ann Surg. 2018;267:419–425.
Adam R, Karam V, Cailliez V, et al. 2018 Annual Report of the European Liver Transplant Registry (ELTR)—50-year evolution of liver transplantation. Transpl Int. 2018;31:1293–1317.
Lim C, Turco C, Balci D, et al. Auxiliary liver transplantation for cirrhosis: from AOLT to RAPID: a scoping review. Ann Surg. 2022;275:551–559.
Nadalin S, Settmacher U, Rauchfuß F, et al. RAPID procedure for colorectal cancer liver metastasis. Int J Surg. 2020;82S:93–96.
Balci D, Kirimker EO, BingolKologlu M, et al. A new approach for increasing availability of liver grafts and donor safety in living donor liver transplantation: LD-RAPID Procedure in the cirrhotic setting with hepatocellular carcinoma. Liver Transpl. 2021;27:590–594.
Dokmak S, Elkrief L, Belghiti J. Auxiliary liver transplantation with a small deceased liver graft for cirrhotic liver complicated by hepatocellular carcinoma. Transpl Int. 2013;26:e102–e104.
Soubrane O. Commentary on Balci et al “RAPID in Cirrhosis: Watch Out for Blood Flow!”. Ann Surg. 2022;275:e540.
Germani G, Theocharidou E, Adam R, et al. Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database. J Hepatol. 2012;57:288–296.
Rela M. Technique of hepatic arterial anastomosis in living donor pediatric auxiliary partial orthotopic liver transplantation. Liver Transpl. 2013;19:1046–1048.