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Qu W, Zhu ZJ, Wei L. A novel approach for portal system reconstruction in liver transplant patients with grade IV portal vein thrombosis: Case study and literature review. FRONTIERS IN TRANSPLANTATION 2022; 1:922881. [PMID: 38994378 PMCID: PMC11235255 DOI: 10.3389/frtra.2022.922881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/18/2022] [Indexed: 07/13/2024]
Abstract
Background Portal vein thrombosis is a common problem of end-stage liver disease in patients with portal hypertension and Yerdel grade IV thrombosis may be a contraindication for liver transplantation. Advances in surgical technique have indicated the feasibility of liver transplantation with PVT such as Reno-portal anastomosis, cavo-portal hemitransposition, but low graft portal blood perfusion and regional portal hypertension were the limitations. Methods We introduce a new approach for portal system reconstruction in a patient underwent liver transplantation: A 28-year-old male was diagnosed with Budd-Chari syndrome and portal hypertension with grade IV portal vein thrombosis. Results The "Pull-out" technique was applicated for thrombectomy, which can aid in exposing the superior mesenteric vein and portal vein branches and reducing technical difficulties associated with the identification and dissociation of surrounding anatomical structures. To collect sufficient portal vein blood perfusion and avoid regional portal hypertension, the portal vein system was reconstructed through double-approach procedure: reno-portal anastomosis combined with portal-portal anastomosis. Conclusion Based on a precision preoperative evaluation, application of the Pull-out technique and double-approach procedure may be an effective method of thrombectomy especially in cases of grade IV portal vein thrombosis.
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Affiliation(s)
- Wei Qu
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Beijing, China
| | - Zhi-Jun Zhu
- National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Beijing, China
| | - Lin Wei
- National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Beijing, China
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2
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Perdigoto DN, Tomé L, Diogo D, Ferrão J, Martins R, Oliveira P, Tralhão G, Furtado E. Auxiliary Liver Transplantation as a Transient Treatment for Acute Liver Failure: Two Cases. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 26:54-58. [PMID: 30675504 DOI: 10.1159/000487155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/25/2018] [Indexed: 12/30/2022]
Abstract
Introduction Acute liver failure is an uncommon condition associated with a high mortality. Most patients do not survive without liver transplantation. In the last decades, auxiliary liver transplantation has emerged as a therapeutic option. Clinical Case The authors present two cases of acute liver failure that required liver transplantation. Given the patients' young age and the preserved macroscopic liver pattern evaluated in surgery, auxiliary liver transplantation was executed using different surgical approaches. Afterwards, following confirmed full native liver regeneration, the patients were submitted to auxiliary liver hepatectomy, which was accomplished without complications. Conclusion Auxiliary liver transplantation can be regarded as an effective temporary treatment for acute liver failure in selected cases, allowing an immunosuppression-free life.
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Affiliation(s)
- David N Perdigoto
- Gastroenterology Department, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Luís Tomé
- Gastroenterology Department, Coimbra University and Hospital Centre, Coimbra, Portugal.,Adult and Paediatric Liver Transplantation Unit, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Dulce Diogo
- Adult and Paediatric Liver Transplantation Unit, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - José Ferrão
- Adult and Paediatric Liver Transplantation Unit, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Ricardo Martins
- Adult and Paediatric Liver Transplantation Unit, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Pedro Oliveira
- Adult and Paediatric Liver Transplantation Unit, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Guilherme Tralhão
- Adult and Paediatric Liver Transplantation Unit, Coimbra University and Hospital Centre, Coimbra, Portugal.,General Surgery Department, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Emanuel Furtado
- Adult and Paediatric Liver Transplantation Unit, Coimbra University and Hospital Centre, Coimbra, Portugal
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3
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Ai L, Liang X, Wang Z, Shen J, Yu F, Xie L, Pan Y, Lin H. A Comparison between splenic fossa and subhepatic fossa auxiliary partial heterotopic liver transplantation in a porcine model. Liver Transpl 2016; 22:812-21. [PMID: 26785299 PMCID: PMC5089560 DOI: 10.1002/lt.24397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 12/15/2015] [Accepted: 12/31/2015] [Indexed: 01/13/2023]
Abstract
To test the alternative possible locations for the placement of a liver graft and the relevant surgical technique issues, we developed a porcine model of auxiliary partial heterotopic liver transplantation (APHLT) and evaluated the difference between 2 styles of liver transplantation, either subhepatic fossa or splenic fossa APHLT, by comparing survival and biochemical indexes. Thirty-eight miniature pigs were randomly divided into 2 groups. A left hemihepatic graft without the middle hepatic vein (HV) was procured from the living donor. In group A (n = 9), an 8 mm diameter polytetrafluoroethylene (PTFE) graft approximately 2.5 cm long was connected to the left HV while another PTFE graft of the same size was connected to the left portal vein (PV). The liver graft was implanted in the right subhepatic fossa following splenectomy and right nephrectomy. In group B (n = 10), a PTFE graft of the same size was connected to the left HV while the liver graft was implanted in the splenic fossa following splenectomy and left nephrectomy. Survival rate and complications were observed at 2 weeks after transplantation. Data were collected from 5 animals in group A and 6 animals in group B that survived longer than 2 weeks. The liver function and renal function of the recipients returned to normal at 1 week after surgery in both groups. Eighty-eight percent (14/16) of the PTFE grafts remained patent at 2 weeks after surgery, but 44% of the PTFE grafts (7/16) developed mural thrombus. No significant differences in the survival rate and biochemistry were found between the 2 groups. In conclusion, the splenic fossa APHLT can achieve beneficial outcomes similar to the subhepatic fossa APHLT in miniature pigs, although it also has a high morbidity rate due to hepatic artery thrombosis, PV thrombosis, and PTEF graft mural thrombus formation. Liver Transplantation 22 812-821 2016 AASLD.
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Affiliation(s)
- Lemin Ai
- Department of General SurgeryThe People's First Hospital of XiaoshanHangzhouZhejiang ProvincePeople's Republic of China
| | - Xiao Liang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouZhejiang ProvincePeople's Republic of China
| | - Zhifei Wang
- Department of General SurgeryZhejiang Province People's HospitalHangzhouZhejiang ProvincePeople's Republic of China
| | - Jie Shen
- Department of General SurgeryThe People's First Hospital of XiaoshanHangzhouZhejiang ProvincePeople's Republic of China
| | - Feiyan Yu
- Department of General SurgeryThe People's First Hospital of XiaoshanHangzhouZhejiang ProvincePeople's Republic of China
| | - Limei Xie
- Department of General SurgeryThe People's First Hospital of XiaoshanHangzhouZhejiang ProvincePeople's Republic of China
| | - Yongming Pan
- Laboratory Animal Research CenterZhejiang Chinese Medical UniversityHangzhouZhejiang ProvincePeople's Republic of China
| | - Hui Lin
- Department of General Surgery, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouZhejiang ProvincePeople's Republic of China
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Ringers J, Bloemenkamp K, Francisco N, Blok JJ, Arbous MS, van Hoek B. Auxiliary or orthotopic liver transplantation for acute fatty liver of pregnancy: case series and review of the literature. BJOG 2015; 123:1394-1398. [PMID: 26449726 DOI: 10.1111/1471-0528.13707] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2015] [Indexed: 12/17/2022]
Affiliation(s)
- J Ringers
- Department of Transplant Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Kwm Bloemenkamp
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - N Francisco
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J J Blok
- Department of Transplant Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - M S Arbous
- Department of Intensive Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - B van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
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Zhang J, Xi J, Dong C, Meng X. Effects of dual arterial blood supply on liver regeneration in the graft and the host following heterotopic auxiliary liver transplantation. Exp Ther Med 2014; 8:1428-1432. [PMID: 25289034 PMCID: PMC4186488 DOI: 10.3892/etm.2014.1976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 08/14/2014] [Indexed: 11/06/2022] Open
Abstract
This study aimed to investigate the effect of the dual arterial blood supply method used in auxiliary liver transplantation on the regeneration of grafted and host liver. A total of 72 male Sprague-Dawley rats were randomly assigned to three experimental groups, namely the 68% hepatectomy group (group A), the 68% hepatectomy with dual arterial blood supply group (group B) and the auxiliary liver transplantation with dual arterial blood supply group (group C). Group C was further divided into the host liver subgroup (group Ca) and the transplanted liver subgroup (group Cb). Six animals from each group were sacrificed at 1, 2 and 7 days after surgery. The calculation of the liver regeneration rate (LRR) was based on measuring liver weight. Liver function was assessed by measuring serum alanine aminotransferase (ALT) levels. Immunohistochemistry was employed to detect the expression of proliferating cell nuclear antigen (PCNA). Apoptotic changes in the grafts and host livers were evaluated using TUNEL staining. The LRR in each group exhibited a tendency to increase over time. At each time point, the LRR of transplanted livers in group C exhibited no significant difference from that of host livers in group C (P>0.05). The ALT levels for each group exhibited a time-dependent decreasing tendency. The ALT level in group C was significantly higher compared to that in groups A and B at each time point (P<0.05). The expression of PCNA in transplanted and host livers in group C was significantly lower compared to that in groups A and B at the same time point (P<0.001). Although the number of apoptotic cells in each group varied at different time points, there was no statistically significant difference (P>0.05). In auxiliary liver transplantation with the dual arterial blood supply method, the capacity of the liver regeneration in the grafts was similar to that of the host livers. Therefore, this technique may reduce the potential risk of graft liver atrophy caused by functional competition.
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Affiliation(s)
- Junjing Zhang
- Department of General Surgery, Affiliated Hospital of Inner Mongolia Medical University, Huhhot, Inner Mongolia 010050, P.R. China
| | - Junqing Xi
- Department of General Surgery, Affiliated Hospital of Inner Mongolia Medical University, Huhhot, Inner Mongolia 010050, P.R. China
| | - Chaoxuan Dong
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Xingkai Meng
- Department of General Surgery, Affiliated Hospital of Inner Mongolia Medical University, Huhhot, Inner Mongolia 010050, P.R. China
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Akbulut S, Kayaalp C, Yilmaz M, Yilmaz S. Auxiliary reno-portal anastomosis in living donor liver transplantation: a technique for recipients with low portal inflow. Transpl Int 2012; 25:e73-5. [PMID: 22487422 DOI: 10.1111/j.1432-2277.2012.01471.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Caval inflow to the graft for liver transplantation in patients with diffuse portal vein thrombosis: a 12-year experience. Ann Surg 2012; 254:1008-16. [PMID: 21869678 DOI: 10.1097/sla.0b013e31822d7894] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To analyze the short- and long-term results of cavoportal anastomosis (CPA) and renoportal anastomosis (RPA) in 20 consecutive liver transplantation (LT) candidates with diffuse portal vein thrombosis (PVT). SUMMARY BACKGROUND DATA Caval inflow to the graft (CIG) by CPA or RPA has been the most commonly used salvage technique to overcome the absolute contraindication for LT in case of diffuse PVT. METHODS From 1996 to 2009, 3 patients (15%) underwent CPA and 17 patients (85%) had an RPA during LT. In addition to routine follow-up, patients were specifically evaluated for signs of portal hypertension (PHT) and for patency of the anastomoses. The follow-up ranged from 3 months to 12 years (median of 4.5 years). RESULTS : Caval inflow to the graft was feasible in all attempted cases. In the short term (<6 months), 35% of patients had residual PHT-related complications (massive ascites and variceal bleeding). These resolved spontaneously or with endoscopic management. Three deaths occurred; none was related to PHT or shunt thrombosis. In the long term (>6 months), 1 death occurred because of recurrent variceal bleeding after RPA thrombosis. At last follow-up, all living patients [n = 13 (65%)] had normal liver function, no signs of PHT and patent anastomoses. There were no retransplantations. Graft and patient survival at 1, 3, and 5 years were 83%, 75%, and 60%, respectively. CONCLUSIONS Caval inflow to the graft is an efficacious salvage technique with satisfactory long-term results, considering the spontaneous outcome in patients denied LT because of diffuse PVT. Adequate preoperative management of PHT and its associated complications is vital in obtaining good results. In the long term, residual PHT resolves and the liver function returns to normal.
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Sutaria R, Adams DH. Efforts to expand the donor pool for liver transplantation. F1000 MEDICINE REPORTS 2010; 2. [PMID: 20948842 PMCID: PMC2950055 DOI: 10.3410/m2-42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Liver transplantation has become a victim of its own success in that there are no longer enough suitable livers for transplantation while at the same time the indications for transplantation increase. Efforts to expand the number of recipients who benefit from this life-saving procedure are being made, in particular through the use of split grafts and live donors. However, such grafts are associated with increased morbidity and mortality related to their reduced size.
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Affiliation(s)
- Rupesh Sutaria
- Centre for Liver Research, 5th Floor, Institute of Biomedical Research, University of BirminghamWolfson Drive, Edgbaston, Birmingham, B15 2TTUK
- National Institute for Health Research (NIHR) Biomedical Research Unit in Liver Disease, Queen Elizabeth HospitalEdgbaston, Birmingham, B15 2TTUK
| | - David H Adams
- Centre for Liver Research, 5th Floor, Institute of Biomedical Research, University of BirminghamWolfson Drive, Edgbaston, Birmingham, B15 2TTUK
- National Institute for Health Research (NIHR) Biomedical Research Unit in Liver Disease, Queen Elizabeth HospitalEdgbaston, Birmingham, B15 2TTUK
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9
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Polak WG, Peeters PM, Slooff MJ. The evolution of surgical techniques in clinical liver transplantation. A review. Clin Transplant 2009; 23:546-64. [DOI: 10.1111/j.1399-0012.2009.00994.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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10
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22 Levertransplantatie. LEVERZIEKTEN 2009. [PMCID: PMC7121307 DOI: 10.1007/978-90-313-7437-3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 1963 verrichtte Thomas Starzl in Denver de eerste levertransplantatie bij de mens. In 1966 werden in Nederland de eerste twee (auxiliaire, zie par. 22.3.6) levertransplantaties verricht in Leiden en Arnhem, in 1968 startte Cambridge. Helaas resulteerden de eerste levertransplantaties niet in langetermijnoverleving als gevolg van niet-optimale operatietechniek, matige immuunsuppressie en onbekendheid met complicaties.
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11
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Ikegami T, Shimada M, Imura S, Arakawa Y, Nii A, Morine Y, Kanemura H. Current concept of small-for-size grafts in living donor liver transplantation. Surg Today 2008; 38:971-82. [PMID: 18958553 DOI: 10.1007/s00595-008-3771-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Accepted: 02/18/2008] [Indexed: 12/16/2022]
Abstract
The extended application of living donor liver transplantation (LDLT) has revealed the problem of graft size mismatching called "small-for-size (SFS) graft syndrome." The initial trials to resolve this problem involved increasing the procured graft size, from left to right, and even extension to include a right lobe graft. Clinical cases of living right lobe donations have been reported since then, drawing attention to the risks of increasing the liver volume procured from a living donor. However, not only other modes of increasing graft volume such as auxiliary or dual liver transplantation, but also control of the increased portal pressure caused by an SFS graft, such as a portosystemic shunt or splenectomy, have been trialed with some positive results. To establish an effective strategy for transplanting SFS grafts and preventing SFS graft syndrome, it is essential to have precise knowledge and tactics to evaluate graft quality and graft volume, when performing these LDLTs with portal pressure control. We reviewed the updated literature on the pathogenesis of and strategies for using SFS grafts.
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Affiliation(s)
- Toru Ikegami
- Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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Ikegami T, Taketomi A, Soejima Y, Yoshizumi T, Sanefuji K, Kayashima H, Shimada M, Maehara Y. Living donor liver transplantation for acute liver failure: a 10-year experience in a single center. J Am Coll Surg 2007; 206:412-8. [PMID: 18308209 DOI: 10.1016/j.jamcollsurg.2007.08.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 08/14/2007] [Accepted: 08/31/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Living donor liver transplantation has become an accepted treatment for various terminal liver diseases. STUDY DESIGN Forty-two living donor liver transplantations performed for acute liver failure during a 10-year period at Kyushu University Hospital were reviewed. RESULTS Causes of liver failure included hepatitis B (n=12), hepatitis C (n=1), autoimmune hepatitis (n=2), Wilson's disease (n=3), and unknown causes (n=24). The graft types were: left lobe (n=33), right lobe (n=8), and lateral segment (n=1). The mean graft volume to standard liver volume ratios were 42.2+/-9.2% in left lobe grafts and 50.5+/-3.9% in right lobe grafts (p < 0.05). Extubation was significantly delayed in grade IV encephalopathy patients (73.7 +/-18.2 hours) compared with patients with other grades (p < 0.01 to grades I and II, p < 0.05 to grade III). All other patients, except one with a subarachnoid hemorrhage, had complete neurologic recovery after transplantation. The 1- and 10-year survival rates were 77.6% and 65.5%, respectively, for grafts, and 80.0% and 68.2%, respectively, for patients. CONCLUSIONS Outcomes of living donor liver transplantation for acute liver failure are fairly acceptable despite severe general conditions and emergent transplant settings. Living donor liver transplantation is now among the currently accepted life-saving treatments of choice for acute liver failure, although innovative medical treatments for this disease entity are still anticipated.
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Affiliation(s)
- Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Ringers J, Dubbeld J, Baranski AG, Coenraad M, Sarton E, Schaapherder AFM, van Hoek B. Reuse of auxiliary liver grafts in second recipients with chronic liver disease. Am J Transplant 2007; 7:2615-8. [PMID: 17927609 DOI: 10.1111/j.1600-6143.2007.01959.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We describe the first cases of reuse of auxiliary liver grafts for orthotopic transplantation in chronic liver disease. A reduced liver graft (segments 2, 3, half of 4) was first transplanted auxiliary for acute liver failure using a new technique. After regeneration of both native liver and graft, the auxiliary graft was removed and immunosuppression discontinued in the first recipients. After informed consent of donors and recipients, both auxiliary grafts were then orthotopically transplanted into second recipients. Both grafts function normally. Reuse of auxiliary grafts may help to reduce the shortage or liver grafts available for transplantation.
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Affiliation(s)
- J Ringers
- Department of Transplant Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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