AUXILIARY ORTHOTOPIC TRANSPLANTATION AS A RESCUE FOR SMALL-FOR-SIZE GRAFTS IN LIVING-DONOR LIVER TRANSPLANT PROGRAM

Abstract

28 Background and aims. Living-donor liver transplant (LDLT) program with no or scarce support from cadaveric organ source is confronted with the difficulties relating with small-for-size grafts. Some centers are adopting right-lobe grafting with known risk for living donors. This paper reports our initial results in auxiliary LDLT as another possible solution to the problem. Methods. In the period from September 1996 to December 1997, 5 elective patients underwent auxiliary orthotopic LDLT in our center as a compensatory procedure for small-for-size grafts. Original diseases were biliary atresia in two, Wilson's disease in two, and primary biliary cirrhosis. Recipient age, body weight, donor-to-recipient weight ratio, and graft-to-recipient weight ratio ranged respectively from 15 to 48 years, from 50 to 62 kg, from 0.79 to 1.28, and from 0.48 to 0.72%. Graft donors were 4 parents and one sibling, all of which were ABO-compatible with the recipients. Left-lobe grafts were implanted after lateral segmentectomy or caudate lobectomy of the native liver. Except initial two cases portal venous inflow to the remnant native liver was interrupted to prevent deprivation of graft inflow. Results. Posttransplant bilirubin clearance and prothrombin time were better with this technique despite cirrhotic changes in the remnant native livers. All the grafts grew in size with gradual atrophy of the remnant native livers. All of the 5 patients of auxiliary LDLT are at present well at home 5-15 months after operation. In contrast, graft survival in elective ABO-compatible cases with graft-to-recipient weight ratio less than 0.8% (n=16) was 75%, 63%, and 56% at 1, 3, and 6 months without this technique. Conclusions. Though special attention for the reactivation of original diseases and for future possible carcinogenesis in the remnant native liver is necessary, auxiliary orthotopic transplantation is a safe technique that can serve a definite rescue for patients whose available grafts are considerably small-for-size. Second-stage native hepatectomy could be indicated in some cases.