Emergency subtotal hepatectomy: a new concept for acetaminophen-induced acute liver failure: temporary hepatic support by auxiliary orthotopic liver transplantation enables long-term success
| Autor: | Magdy Attia, Giles J. Toogood, Charles E. Millson, K. Rajendra Prasad, Judith I. Wyatt, N Snook, Philip Robinson, Niall P. Breslin, Dowmitra Dasgupta, Stephen Pollard, J. Peter A. Lodge, Mervyn H. Davies, M. C. Bellamy |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Orthotopic liver transplantation Adolescent medicine.medical_treatment Insuficiencia hepatica Pilot Projects Liver transplantation medicine Hepatectomy Humans Subtotal hepatectomy Acetaminophen Retrospective Studies business.industry digestive oral and skin physiology Liver failure Analgesics Non-Narcotic Liver Failure Acute Middle Aged Surgery Liver Transplantation Survival Rate Treatment Outcome Quality of Life Female business medicine.drug Follow-Up Studies |
| Zdroj: | Annals of surgery. 247(2) |
| ISSN: | 0003-4932 |
| Popis: | Acetaminophen (paracetamol) overdose (AOD) has recently emerged as the leading cause of acute liver failure (ALF) in the United States, with an incidence approaching that seen in the United Kingdom. We describe a new way to treat AOD ALF patients fulfilling King's College criteria for "super-urgent" liver transplantation.Beginning in June 1998, we have been piloting a clinical program of subtotal hepatectomy and auxiliary orthotopic liver transplantation (ALT) for AOD ALF. Our technique is based on the following principles: (1) subtotal hepatectomy; (2) auxiliary transplantation of a whole liver graft; (3) gradual withdrawal of immunosuppression after recovery. Results were compared with patients who had undergone an orthotopic liver transplantation (OLT) for AOD ALF in the same period. Quality of life comparisons were made using the SF36 questionnaire.Thirteen patients underwent this procedure between June 1998 and March 2005. Median survival is 68 months (range, 0-102 m). Actual survival data show that 9 of 13 patients are alive (69%) compared with 7 of 13 OLT patients (54%). One ALT patient required a retransplantation with an OLT due to hepatic vein thrombosis, and immunosuppression is therefore maintained. The other 8 surviving ALT patients are off immunosuppression. These 8 ALT patients have normal liver function and have a better quality of life compared with the 7 surviving OLT patients.Our results with this new technique are encouraging: 69% actual survival, no long-term immunosuppression requirement, and improved quality of life in the 62% successful cases. |
| Databáze: | OpenAIRE |
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