Clinical study of autologous liver transplantation: a report of 36 cases

Abstract

Objective To study the clinical value of autologous liver tranplantation (ALT) for the treatment of liver occupying lesion which can not be resected by conventional techniques.Methods The clinical data of 36 patients who received ALT at the Zhongnan Hospital of Wuhan University from May 2005 to December 2011 were retrospectively analyzed.The preoperative evaluation,intra-and postoperative conditions of the patients were analyzed.All the patients were followed up via phone call or out-patient examination till March 2013.The survival curve was drawn by Kaplan-Meier method.Results The preoperative hepatic function of 34 patients was in ChildPugh grade A,and 2 in Child-Pugh grade B.The HBsAg was positive in 20 patients and negative in 16 patients.Thirty-six patients received ALT.The operation time was (8.3 ± 1.5)hours,and the anhepatic phase was (245 ±12)minutes,the median volume of intraoperative blood loss was 600 ml.The operation was successful except 2 patients suffered from severe arrhythmia.The mean time for hepatic function recovery after the operation was (10 ±5)days.The median time for hospital stay and postoperative hospital stay were 28.5 days and 24.0 days,respectively.The time for alanine transaminase,aspartate transaminase and total bilirubin to reach the peak level were (1.7 ± 0.8) days,(1.3 ± 0.6) days and (2.5 ± 1.4) days,respectively.Thirty-four patients were followed up with the rate of 94.4％ (34/36),and the median follow-up time was 4 years.Thirteen patients suffered from benign disease.One patient with hydatidosis invading the hilar bile duct and common bile duct had hydatidosis recurrence at postoperative month 5,and he received radiofrequency ablation.Of the 20 patients with hepatic cancer,9 had tumor recurrence or metastasis (1 missed follow-up,7 died and 1 survived for 5.4 years).Of the 2 patients with hepatic vein invaded by right renal carcinoma,1 missed follow-up and 1 survived for 4.4 years.One patient had hepatic metastatic tumor recurrence at postoperative month 5.The 1-,2-,3-year survival rates of the 36 patients were 75％,71％ and 68％,and the 1-,2-,3-year survival rates of patients with malignant tumor were 65％,59％ and 54％,respectively.Conclusion After comprehensive preoperative assessment,rigorous screening indications,adequate preoperative preparation and improved surgical techniques,ALT could reduce early postoperative mortality and lengthen the survival time. Key words: Liver transplantation, autologous ; Efficacy ; Survival rate