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 microM (51-389 microM) and bilirubin 320 microM (61-572 microM). The reasons for performing an auxiliary transplant were the patients' 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 aminotransferase fell progressively in all patients, with median values at day 7 of 1.4 (1.0-2.4) and 108 IU/1 (78-910 IU/1). 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.

译文

背景/目的 : 辅助部分原位肝移植比常规原位肝移植具有潜在的优势,但在急性肝衰竭方面的技术经验有限。
方法 : 我们描述了7例急性肝衰竭 (扑热息痛3,非A-E 2,自身免疫性1,摇头丸1) 符合标准的患者 (4名男性,3名女性; 平均年龄28岁,范围14-35岁) 的初步经验。紧急移植。术前,国际标准化比率中位数为7 (范围3.4-15),肌酐为123微米 (51-389微米),胆红素320微米 (61-572微米)。进行辅助移植的原因是患者的年龄较小且术前状况稳定 (n = 5),或者有明显的精神病史而无法进行常规移植 (n = 2)。
结果 : 所有患者均接受了血型匹配的左 (n = 2) 或右 (n = 5) 辅助移植物。手术的中位持续时间为8.5小时 (7.3-10小时),失血量为8.3升 (4.6-14.6升)。移植后,所有患者的国际标准化比率和天冬氨酸转氨酶均逐渐下降,在1.4第7天 (1.0-2.4) 和108 IU/1 (78-910 IU/1) 的中位数。术后第一个月内有3名患者死于败血症。在2周时,六名患者中有四名患者的天然肝脏部分再生,其中两名幸存者在1年内完全再生。
结论 : 尽管患者选择的定义仍然很差,在急性肝衰竭中进行辅助部分原位肝移植在技术上是可行的,并且在某些患者中,允许天然肝脏再生并最终退出免疫抑制。

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