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Auxiliary partial orthotopic liver transplantation (APOLT) entails the removal of part of the native liver and replacement with the corresponding part of donor liver. APOLT is usually performed for acute liver failure and metabolic liver disease. However, many technical concerns limit its acceptance globally. In this study, we describe our experience of 6 APOLT performed for acute liver failure. Out of the 68 liver transplants performed in our center for acute liver failure, six were APOLT. APOLT was performed in the setting of hyperacute liver failure with no other organ failure. The recovery of the native liver was assessed using hepatobiliary scintigraphy every six months. Immunosuppressant withdrawal was attempted once 50% recovery of the native liver was attained in the scan. All donors were first-degree relatives. Etiology was hepatitis A in 4 patients, yellow phosphorous poisoning in 1, and cryptogenic fulminant hepatic failure in the remaining 1 patient. Five of them were blood group identical and one was ABO incompatible (AB to A). Post-operatively, three patients died, two due to massive cerebral edema, and one due to sepsis. All the survivors at a follow-up period of 2 years are off immunosuppressants and are doing well. Auxiliary liver transplant in acute liver failure has a poor success rate. However, the technique can be considered in a very selected group of patients with hepatitis A-related hyperacute liver failure. [ABSTRACT FROM AUTHOR]

Small bowel transplants are performed all over the world with acceptable success rates. Although there are isolated reports of small bowel transplants from India, a robust intestinal transplant programme similar to western countries is lacking. Our aim is to share our experience to build up on the evolving field of small bowel transplants in India. Deceased donor small bowel transplant was performed for three patients with intestinal failure, two for short gut syndrome following surgery and one for visceral myopathy. All were on preoperative total parenteral nutrition for varying periods of time (6 to 13 months). There were multiple episodes of line sepsis in all patients. Post-transplant, all received induction immunosuppression with anti-thymocyte globulin (first two patients) or alemtuzumab (3rd patient). All had systemic venous drainage and stoma. Protocol weekly intestinal biopsies were done in all patients. All died in hospital at 24, 12 and 28 days following surgery. Biopsy-proven rejection was observed in only patient who had received ABO-compatible non-identical graft (O to A). This patient subsequently developed vascular thrombosis necessitating explant of the graft. Sepsis due to multidrug resistant bacteria was the reason for mortality in the remaining two patients. Despite the absence of technical complications, successful small bowel transplant seems to be an elusive entity for the Indian transplant community. [ABSTRACT FROM AUTHOR]