Auxiliary partial orthotopic liver transplantation for acute liver failure

Background/Aims: Auxiliary partial orthotopic liver transplantation holds potential advantages over conventional orthotopic liver transplantation, but experience with the technique in acute liver failure is limited. Methods: We describe our initial experience in seven patients (4 men, 3 women; mean age 28, range 14–35 years) with acute liver failure (paracetamol 3, non A-E 2, autoimmune 1, Ecstasy 1) who fulfilled criteria for emergency transplantation. Preoperatively, the median international normalised ratio was seven (range 3.4–15), with a creatinine of 123 μM (51–389 μM) and bilirubin 320 μM (61–572 μM). The reasons for performing an auxiliary transplant were the patientsʹ young age and stable preoperative condition (n=5), or a significant psychiatric history precluding conventional transplantation (n=2). Results: All patients received blood group-matched left (n=2) or right (n=5) auxiliary grafts. Median duration of surgery was 8.5 h (7.3–10 h), with blood loss of 8.3 litres (4.6–14.6 litres). Post-transplant, the international normalised ratio and aspartate amino-transferase fell progressively in all patients, with median values at day 7 of 1.4 (1.0–2.4) and 108 IU/l (78–910 IU/l). Three patients died from sepsis within the first postoperative month. At 2 weeks, four of six patients had partial regeneration of the native liver, which became complete in two of the survivors by 1 year. Conclusions: Although patient selection remains poorly defined, auxiliary partial orthotopic liver transplantation in acute liver failure is technically feasible and, in some patients, allows native liver regeneration and eventual immunosuppression withdrawal.