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Auxiliary Liver Transplantation for Acute Liver Failure in Children

Faraj, Walid MD; Dar, Faisal FRCS; Bartlett, Adam MD; Melendez, Hector Vilca MD, PhD; Marangoni, Gabriele MD; Mukherji, Deborah MRCP; Vergani, Georgina Mieli MD; Dhawan, Anil MD, PhD; Heaton, Nigel FRCS; Rela, Mohamed FRCS

doi: 10.1097/SLA.0b013e3181bdfef6
Original Articles

Objective: The aim of this study is to present the largest experience of auxiliary liver transplantation for acute liver failure (ALF) in children over the past 19 years.

Methods: Between 1990 and 2009, a total of 128 liver transplants were performed on children with ALF. Of these, 20 received auxiliary liver transplants (19 were cadaveric and 1 living graft). The recipient median age was 12 years (range: 1 –16). Indications for auxiliary partial orthotopic liver transplantation were seronegative non-A non-B hepatitis in 16 children, drug induced in 2, and 1 autoimmune hepatitis and 1 mushroom poisoning. The median waiting time for transplantation was 2 days (range: 1–9). After native liver partial hepatectomy, 20 grafts were implanted orthotopically and included 8 right lobes, 8 left lateral segments, 3 left lobes, and 1 whole liver. Regeneration of the native liver was assessed by radiologic, nuclear medicine imaging, and histology. Follow-up imaging and biopsies were performed at intervals of 3 to 6 months and yearly.

Results: Patient survival was 85% at 1, 5, and 10 years. There were 3 deaths at a median of 9 days (range: 8–52) post-transplantation. There was 1 retransplant for chronic rejection 15 months post-transplantation. There were no biliary or vascular complications. Of 17 survivors, 14 (82%) have successfully regenerated their native liver and so far 11 children (65% of the survivors) have been withdrawn from immunosuppression at a median time of 23 months (range: 4–106) after transplantation.

Conclusion: Auxiliary partial orthotopic liver transplantation should be considered in children presenting with ALF who fulfill criteria for liver transplantation.

This study represents a retrospective review of 20 auxiliary liver transplantation for acute liver failure in children performed from 1990 to 2009.

From the King's College London School of Medicine at King's College Hospital, Institute of Liver Studies, London, United Kingdom.

Reprints: Mohamed Rela, FRCS, King's College London School of Medicine, King's College Hospital, Institute of Liver Studies, Denmark Hill, SE5 9RS, London, United Kingdom. E-mail: mohamed.rela@kcl.ac.uk.

© 2010 Lippincott Williams & Wilkins, Inc.