Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 8, 2016; 8(4): 226-230
Published online Feb 8, 2016. doi: 10.4254/wjh.v8.i4.226
Total hepatectomy and liver transplantation as a two-stage procedure for fulminant hepatic failure: A safe procedure in exceptional circumstances
Rebeca Sanabria Mateos, Niamh M Hogan, Dimitri Dorcaratto, Helen Heneghan, Venkatesh Udupa, Donal Maguire, Justin Geoghegan, Emir Hoti
Rebeca Sanabria Mateos, Niamh M Hogan, Dimitri Dorcaratto, Helen Heneghan, Venkatesh Udupa, Donal Maguire, Justin Geoghegan, Emir Hoti, Hepatobiliary and Liver Transplant Surgical Unit, St. Vincent’s University Hospital, Dublin 4, Ireland
Author contributions: Sanabria Mateos R designed and performed the research and wrote the paper; Hogan NM supervised the report; Dorcaratto D designed the research and contributed to the analysis; Heneghan H and Udupa V supervised the report; Maguire D, Geoghegan J and Hoti E provided clinical advice and supervised the report.
Institutional review board statement: This study was reviewed and approved by St. Vincent’s University Hospital Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent because the analyses use anonymous clinical data.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Rebeca Sanabria Mateos, Hepatobiliary and Liver Transplant Unit, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland.
Telephone: +353-1-2214000
Received: November 3, 2015
Peer-review started: November 3, 2015
First decision: December 4, 2015
Revised: December 17, 2015
Accepted: January 16, 2016
Article in press: January 19, 2016
Published online: February 8, 2016

AIM: To evaluate the outcomes of two-stage liver transplant at a single institution, between 1993 and March 2015.

METHODS: We reviewed our institutional experience with emergency hepatectomy followed by transplantation for fulminant liver failure over a twenty-year period. A retrospective review of a prospectively maintained liver transplant database was undertaken at a national liver transplant centre. Demographic data, clinical presentation, preoperative investigations, cardiocirculatory parameters, operative and postoperative data were recorded.

RESULTS: In the study period, six two-stage liver transplants were undertaken. Indications for transplantation included acute paracetamol poisoning (n = 3), fulminant hepatitis A (n = 1), trauma (n = 1) and exertional heat stroke (n = 1). Anhepatic time ranged from 330 to 2640 min. All patients demonstrated systemic inflammatory response syndrome in the first post-operative week and the incidence of sepsis was high at 50%. There was one mortality, secondary to cardiac arrest 12 h following re-perfusion. Two patients required re-transplantation secondary to arterial thrombosis. At a median follow-up of 112 mo, 5 of 6 patients are alive and without evidence of graft dysfunciton.

CONCLUSION: Two-stage liver transplantation represents a safe and potentially life-saving treatment for carefully selected exceptional cases of fulminant hepatic failure.

Keywords: Two-stage liver transplantation, Fulminant hepatic failure, Liver transplant, Survival

Core tip: We share our experience with selected cases of emergency total hepatectomy followed by liver transplantation for fulminant hepatic failure. This involves initial haemodynamic stabilization by recipient hepatectomy, creating a temporary porto-caval shunt to permit venous drainage during a variable anhepatic phase, then orthotopic transplantation once a suitable donor graft is available.