Auxiliary partial liver transplantation for end-stage chronic liver disease
| Autor: | Onno T. Terpstra, Solko W. Schalm, Willem Weimar, Pierre J.A. Willemse, Dieter Baumgartner, Theo H.N. Groenland, Fibo W.J. ten Kate, Robert J. Porte, Sjoerd de Rave, Cornelis B. Reuvers, Jeanne Stibbe, Johan L. Terpstra |
|---|---|
| Rok vydání: | 1988 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty Cirrhosis medicine.medical_treatment Liver transplantation Chronic liver disease Preoperative care Ascites Preoperative Care Methods Medicine Humans Postoperative Period Clotting factor Postoperative Care business.industry Liver Diseases General Medicine Middle Aged medicine.disease Hepatitis B Surgery Liver Transplantation Transplantation surgical procedures operative Chronic Disease Female medicine.symptom Hepatectomy business Immunosuppressive Agents Follow-Up Studies |
| Zdroj: | The New England journal of medicine. 319(23) |
| ISSN: | 0028-4793 |
| Popis: | Auxiliary heterotopic liver transplantation is theoretically attractive because it leaves the recipient's liver in place. The surgical trauma of hepatectomy is avoided, and failure of the graft does not necessarily lead to the death of the patient or a second, emergency transplantation. Another advantage is that matching the body sizes of the donor and the recipient is not mandatory, which increases the number of possible donors. However, previous clinical results of auxiliary liver transplantation have been poor. We performed auxiliary partial liver transplantation in six consecutive patients with end-stage chronic liver disease who were not accepted for orthotopic liver transplantation because they had massive ascites, deficient clotting function, cachexia, or poor pulmonary reserve. The donor liver was transplanted to the right subhepatic region after removal of segments II and III, and it was provided with portal and arterial blood. There were no major changes in hemodynamic measurements during surgery. The mean hospital stay after transplantation was 22.7 days (range, 14 to 29). After a mean follow-up period of 14 months (range, 5 to 23), all patients were alive, with good graft function as demonstrated by scintigraphy, Doppler ultrasonography, and synthesis of clotting factors. From these observations we conclude that auxiliary partial liver transplantation is an attractive alternative to orthotopic liver transplantation in high-risk patients. Its role in other patients who need liver transplants remains to be defined. |
| Databáze: | OpenAIRE |
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