Annals of Surgery

Skip Navigation LinksHome > February 2010 - Volume 251 - Issue 2 > Auxiliary Liver Transplantation for Acute Liver Failure in C...
Annals of Surgery:
doi: 10.1097/SLA.0b013e3181bdfef6
Original Articles

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

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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14 (82%) have successfully regenerated their native liver and so far 11 children (65% of the survivors) have been withdrawn from immunosuppression at a median time of 23 months (range: 4–106) after transplantation.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.

© 2010 Lippincott Williams & Wilkins, Inc.


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