6. Auxiliary Partial Orthotopic Liver Transplantation for Selected Non Cirrhotic Metabolic Liver Disease

Abstract

Background and Aims: Auxiliary Partial Orthotopic Liver Transplantation (APOLT) in selected non-cirrhotic metabolic liver diseases (NCMLD) is a viable alternative to orthotopic liver transplantation as it supplements the function of the native liver with the missing functional protein. APOLT for NCMLD is not universally accepted due to concerns of increased technical complications and long-term graft atrophy. Methods: Review of a prospectively collected database of all paediatric patients (age ≤16 years) who underwent liver transplant for non-cirrhotic MLD (NCMLD), from August 2009 up to June 2017 was performed. Patients were divided into two groups; Group 1 underwent APOLT and group 2 orthotopic liver transplant (OLT). Results: Eighteen OLT and 12 APOLT were performed for NCMLD during the study period. There was no significant difference in the age and weight of the recipients in both groups. All APOLT patients needed intra-operative portal flow modulation. Intraoperative peak and end of surgery lactate were significantly higher in the OLT group, and Cold ischemia time (CIT) was longer in the APOLT group. There were no differences in postoperative liver function tests apart from higher peak INR in the OLT group. The incidence of postoperative complications, duration of hospital stay and 1 & 5 year survivals were similar in both groups. Conclusions: We present the largest series of APOLT for NCMLD. APOLT is a safe and effective alternative to OLT, and may even be better than OLT due to lesser physiological stress, and smoother postoperative period for selected patients with NCMLD. The authors have none to declare.