Published online Feb 8, 2016. doi: 10.4254/wjh.v8.i4.226
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.
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.