Rescue Liver Transplantation for Post-hepatectomy Liver Failure- Single Center Retrospective Analysis

Overview

Journal BMC Surg

Publisher Biomed Central

Specialty General Surgery

Date 2024 Aug 6

PMID 39107752

Authors

Lukasz Masior

Maciej Krasnodebski

Piotr Smoter

Marcin Morawski

Konrad Kobryn

Waclaw Holowko

Wojciech Figiel

Marek Krawczyk

Tadeusz Wroblewski

Michal Grat

Affiliations

Soon will be listed here.

Abstract

Introduction: Liver transplantation (LT) is a well-established method applied for the treatment of various liver diseases, including primary and secondary malignancies, as well as acute liver failure triggered by different mechanisms. In turn, liver failure (PHLF) is the most severe complication observed after liver resection (LR). PHLF is an extremely rare indication for LT. The aim of the present study was to assess the results of LT in patients with PHLF.

Methods: Relevant cases were extracted from the prospectively collected database of all LTs performed in our center. All clinical variables, details of the perioperative course of each patient and long-term follow-up data were thoroughly assessed.

Results: Between January 2000 and August 2023, 2703 LTs were carried out. Among them, six patients underwent LT for PHLF, which accounted for 0.2% of all patients. The median age of the patients was 38 years (range 24-66 years). All patients underwent major liver resection before listing for LT. The 90-day mortality after LT was 66.7% (4 out of 6 patients), and all patients experienced complications in the posttransplant course. One patient required early retransplantation due to primary non-function (PNF). The last two transplanted patients are alive at 7 years and 12 months after LT, respectively.

Conclusions: In an unselected population of patients with PHLF, LT is a very morbid procedure associated with high mortality but should be considered the only life-saving option in this group.

References

Heimbach J, Haddock M, Alberts S, Nyberg S, Ishitani M, Rosen C . Transplantation for hilar cholangiocarcinoma. Liver Transpl. 2004; 10(10 Suppl 2):S65-8. DOI: 10.1002/lt.20266. View

Sparrelid E, Olthof P, Dasari B, Erdmann J, Santol J, Starlinger P . Current evidence on posthepatectomy liver failure: comprehensive review. BJS Open. 2022; 6(6). PMC: 9681670. DOI: 10.1093/bjsopen/zrac142. View

Gong X, Azhdarinia A, Ghosh S, Xiong W, An Z, Liu Q . LGR5-Targeted Antibody-Drug Conjugate Eradicates Gastrointestinal Tumors and Prevents Recurrence. Mol Cancer Ther. 2016; 15(7):1580-90. DOI: 10.1158/1535-7163.MCT-16-0114. View

Pratschke S, Rauch A, Albertsmeier M, Rentsch M, Kirschneck M, Andrassy J . Temporary Intraoperative Porto-Caval Shunts in Piggy-Back Liver Transplantation Reduce Intraoperative Blood Loss and Improve Postoperative Transaminases and Renal Function: A Meta-Analysis. World J Surg. 2016; 40(12):2988-2998. DOI: 10.1007/s00268-016-3656-1. View

Bonney G, Chew C, Lodge P, Hubbard J, Halazun K, Trunecka P . Liver transplantation for non-resectable colorectal liver metastases: the International Hepato-Pancreato-Biliary Association consensus guidelines. Lancet Gastroenterol Hepatol. 2021; 6(11):933-946. DOI: 10.1016/S2468-1253(21)00219-3. View

Rayar M, Levi Sandri G, Cusumano C, Locher C, Houssel-Debry P, Camus C . Benefits of temporary portocaval shunt during orthotopic liver transplantation with vena cava preservation: A propensity score analysis. Liver Transpl. 2016; 23(2):174-183. DOI: 10.1002/lt.24650. View

Masior L, Grat M, Grat K, Krasnodebski M, Wronka K, Stypulkowski J . Importance of Intraoperative Transfusions of Packed Red Blood Cells and Fresh Frozen Plasma in Liver Transplantation for Hepatocellular Cancer. Ann Transplant. 2020; 25:e923665. PMC: 7552880. DOI: 10.12659/AOT.923665. View

Muller P, Linecker M, Kirimker E, Oberkofler C, Clavien P, Balci D . Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: State of the art of parenchyma augmentation-assisted liver surgery. Langenbecks Arch Surg. 2021; 406(7):2201-2215. PMC: 8578101. DOI: 10.1007/s00423-021-02148-2. View

Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F . Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996; 334(11):693-9. DOI: 10.1056/NEJM199603143341104. View

10.

Breuer E, Mueller M, Doyle M, Yang L, Murad S, Anwar I . Liver Transplantation as a New Standard of Care in Patients With Perihilar Cholangiocarcinoma? Results From an International Benchmark Study. Ann Surg. 2022; 276(5):846-853. PMC: 9983747. DOI: 10.1097/SLA.0000000000005641. View

11.

Solheim J, Dueland S, Line P, Hagness M . Transplantation for Nonresectable Colorectal Liver Metastases: Long-Term Follow-Up of the First Prospective Pilot Study. Ann Surg. 2022; 278(2):239-245. DOI: 10.1097/SLA.0000000000005703. View

12.

Sousa Da Silva R, Breuer E, Shankar S, Kawakatsu S, Holowko W, Coelho J . Novel Benchmark Values for Open Major Anatomic Liver Resection in Non-cirrhotic Patients: A Multicentric Study of 44 International Expert Centers. Ann Surg. 2023; 278(5):748-755. DOI: 10.1097/SLA.0000000000006012. View

13.

Otsuka Y, Duffy J, Saab S, Farmer D, Ghobrial R, Hiatt J . Postresection hepatic failure: successful treatment with liver transplantation. Liver Transpl. 2007; 13(5):672-9. DOI: 10.1002/lt.20917. View

14.

Akbulut S, Cicek E, Kolu M, Sahin T, Yilmaz S . Associating liver partition and portal vein ligation for staged hepatectomy for extensive alveolar echinococcosis: First case report in the literature. World J Gastrointest Surg. 2018; 10(1):1-5. PMC: 5785687. DOI: 10.4240/wjgs.v10.i1.1. View

15.

Xu L, Lin W, Wen L, Li G . Lgr5 in cancer biology: functional identification of Lgr5 in cancer progression and potential opportunities for novel therapy. Stem Cell Res Ther. 2019; 10(1):219. PMC: 6664754. DOI: 10.1186/s13287-019-1288-8. View

16.

Baumgartner R, Gilg S, Bjornsson B, Hasselgren K, Ghorbani P, Sauter C . Impact of post-hepatectomy liver failure on morbidity and short- and long-term survival after major hepatectomy. BJS Open. 2022; 6(4). PMC: 9291378. DOI: 10.1093/bjsopen/zrac097. View

17.

Diaz Vico T, Granero Castro P, Alcover Navarro L, Suarez Sanchez A, Mihic Gongora L, Montalva Oron E . Two stage hepatectomy (TSH) versus ALPPS for initially unresectable colorectal liver metastases: A systematic review and meta-analysis. Eur J Surg Oncol. 2022; 49(3):550-559. DOI: 10.1016/j.ejso.2022.11.010. View

18.

Duvoux C, Roudot-Thoraval F, Decaens T, Pessione F, Badran H, Piardi T . Liver transplantation for hepatocellular carcinoma: a model including α-fetoprotein improves the performance of Milan criteria. Gastroenterology. 2012; 143(4):986-94.e3. DOI: 10.1053/j.gastro.2012.05.052. View

19.

Sparrelid E, Thorsen T, Sauter C, Jorns C, Stal P, Nordin A . Liver transplantation in patients with post-hepatectomy liver failure - A Northern European multicenter cohort study. HPB (Oxford). 2022; 24(7):1138-1144. DOI: 10.1016/j.hpb.2021.12.005. View

20.

Mazzaferro V, Sposito C, Zhou J, Pinna A, De Carlis L, Fan J . Metroticket 2.0 Model for Analysis of Competing Risks of Death After Liver Transplantation for Hepatocellular Carcinoma. Gastroenterology. 2017; 154(1):128-139. DOI: 10.1053/j.gastro.2017.09.025. View