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Subtotal hepatectomy and whole graft auxiliary transplantation for acetaminophen-associated acute liver failure.
- Source :
-
HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2014 Mar; Vol. 16 (3), pp. 220-8. Date of Electronic Publication: 2013 Jul 22. - Publication Year :
- 2014
-
Abstract
- Background: An acetominophen overdose (AOD) is the leading cause of acute liver failure (ALF) in the UK and USA. For patients who meet the King's College Hospital criteria, (mortality risk > 85%), an emergency orthotopic liver transplantation (OLT) is conventionally performed with subsequent life-long immunosuppression. A new technique was developed in 1998 for AOD-induced ALF where a subtotal hepatectomy (right hepatic trisectionectomy) and whole graft auxiliary liver transplant (WGALT) was performed with complete withdrawal of immunosupression during the first year post-operatively.<br />Results: During 1998-2010, 68 patients were listed for an emergency transplantation for AOD ALF at our institution: 28 died waiting, 16 underwent OLT and 24 a subtotal hepatectomy with WGALT. Eight OLT (50%) and 16 WGALT remain alive (67%); actuarial survival at 5 years OLT 50%, WGALT 63%, P = 0.37. All patients who had successful WGALT are off immunosuppression. Poor prognostic factors in the WGALT group included higher donor age (40.4 versus 53.9, P = 0.043), requirements for a blood transfusion (4.3 versus 7.6, P = 0.0043) and recipient weight (63.1 versus 54 kg, P = 0.036).<br />Conclusion: Although OLT remains standard practice for AOD-induced ALF, life-long immunosuppression is required. A favourable survival rate using a subtotal hepatectomy and WGALT has been demonstrated, and importantly, all successful patients have undergone complete immunosuppression withdrawal. This technique is advocated for patients who have acetominophen hepatotoxicity requiring liver transplantation.<br /> (© 2013 International Hepato-Pancreato-Biliary Association.)
- Subjects :
- Adolescent
Adult
Chemical and Drug Induced Liver Injury diagnosis
Chemical and Drug Induced Liver Injury etiology
Chemical and Drug Induced Liver Injury mortality
Drug Overdose
Emergencies
Female
Humans
Immunosuppressive Agents administration & dosage
Kaplan-Meier Estimate
Liver Failure, Acute chemically induced
Liver Failure, Acute diagnosis
Liver Failure, Acute mortality
Liver Regeneration
Male
Middle Aged
Risk Factors
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Waiting Lists mortality
Young Adult
Acetaminophen poisoning
Analgesics, Non-Narcotic poisoning
Chemical and Drug Induced Liver Injury surgery
Hepatectomy adverse effects
Hepatectomy mortality
Liver Failure, Acute surgery
Liver Transplantation adverse effects
Liver Transplantation mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1477-2574
- Volume :
- 16
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- HPB : the official journal of the International Hepato Pancreato Biliary Association
- Publication Type :
- Academic Journal
- Accession number :
- 23870048
- Full Text :
- https://doi.org/10.1111/hpb.12124