Auxiliary Partial Orthotopic Living Donor Liver Transplantation: Kyoto University Experience |
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Authors: | Mureo Kasahara Yasutsugu Takada Hiroto Egawa Yasuhiro Fujimoto Yasuhiro Ogura Kohei Ogawa Koichi Kozaki Hironori Haga Mikiko Ueda Koichi Tanaka |
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Affiliation: | Organ Transplant Unit, Kyoto University Hospital, Kyoto, Japan. mureo@kuhp.kyoto-u.ac.jp |
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Abstract: | Auxiliary partial orthotopic liver transplantation (APOLT) was initially indicated as a potentially reversible fulminant hepatic failure and non-cirrhotic metabolic liver disease to compensate for enzyme deficiency without complete removal of the native liver. We expand our indication of APOLT for small-for-size grafts to support the function of implanted grafts during the early post-operative period, and for ABO-incompatibility to sustain a patient's life if the patient has a graft failure. We retrospectively reviewed 31 patients undergoing APOLT from living donor. The indication of APOLT was fulminant hepatic failure in 6, non-cirrhotic metabolic liver disease in 6, small-for-size grafts in 13 and ABO-incompatible cases in 6. The cumulative survival rate for APOLT at 1 and 5 years was 57.9% and 50.6%, and 78.8% and 73.8% for standard LDLT. None of the patients who underwent transplantation with APOLT for fulminant hepatic failure had long-term patient survival. The incidence of acute cellular rejection was higher in APOLT (58.1%) than standard LDLT (35.0%). Biliary complication was higher and the need for retransplantation was greater in APOLT than standard LDLT (p < 0.01). The results suggest that the indications of APOLT should be reconsidered in view of the risk for complications and retransplantation. |
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Keywords: | Auxiliary liver transplantation living donor liver transplantation |
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