Simplified technic for human auxiliary liver transplantation

Auxiliary Liver Transplantation for Cirrhosis: From APOLT to RAPID: A Scoping Review

OBJECTIVE

To survey the available literature regarding the use of auxiliary liver transplantation (ALT) in the setting of cirrhosis.

SUMMARY BACKGROUND

ALT is a type of LT procedure in which part of the cirrhotic liver is resected and part of the liver graft is transplanted. The cirrhotic liver left in situ acts as an auxiliary liver until the graft has reached sufficient volume. Recently, a two-stage concept named RAPID (Resection And Partial LIver segment 2/3 transplantation with Delayed total hepatectomy) was developed, which combines hypertrophy of the small graft followed by delayed removal of the native liver.

METHODS

A scoping review of the literature on ALT for cirrhosis was performed, focusing on the historical background of RAPID and the status of RAPID for this indication. The new comprehensive nomenclature for hepatectomy ("New World" terminology) was used in this review.

RESULTS

A total of 72 cirrhotic patients underwent ALT [heterotopic (n = 34), orthotopic (APOLT, n = 34 including 5 followed by resection of the native liver at the second stage) and RAPID (n = 4)]. Among the 9 two-stage LTs (APOLT, n = 5; RAPID, n = 4), portal blood flow modulation was performed in 6 patients by deportalization of the native liver (n = 4), portosystemic shunt creation (n = 1), splenic artery ligation (n = 3) or splenectomy (n = 1). The delay between the first and second stages ranged from 18 to 90 days. This procedure led to an increase in the graft-to-recipient weight ratio between 33% and 156%. Eight patients were alive at the last follow-up.

CONCLUSIONS

Two-stage LT and, more recently, the RAPID procedure are viable options for increasing the number of transplantations for cirrhotic patients by using small grafts.

Retrieval of organs for transplantation: experience of the Australian National Liver Transplantation Unit

The Australian National Liver Transplantation Unit carried out 251 multiple organ-retrieval procedures between January 1986 and December 1994: 53% were in the Sydney metropolitan area, 22% in country New South Wales and the Australian Capital Territory, 21% interstate and 4% in New Zealand; mean total procurement times were, respectively, 4 hours 57 minutes, 6 hours 58 minutes, 9 hours 20 minutes and 12 hours 20 minutes. Donor operation times steadily decreased over the nine years. One-year patient and graft survival rates were 77.1% and 70.3%, respectively; primary non-function occurred in only one case. The importance of coordination of donor organ procurement and efficient organ retrieval to the success of transplantation programs is discussed.

Transplantation in Australia--50 years of progress

OBJECTIVE

To review the history of clinical transplantation practice in Australia.

DATA SOURCES AND STUDY SELECTION

The first major source was published reports, chiefly in The Medical Journal of Australia (129 articles). The second source was personal communication with those involved in early and current transplantation programs.

DATA EXTRACTION AND SYNTHESIS

The first known transplant of each organ in Australia and the results of current programs have been documented.

CONCLUSIONS

Transplantation of the kidney, liver, heart, lung, pancreas, cornea, or bone marrow are available and accepted therapies for an increasing number of suitable patients, limited mainly by the number of donors.