Ex vivo liver resection and autotransplantation versus allotransplantation for end-stage hepatic alveolar echinococcosis

Abstract

ObjectiveThe aim of this study was to compare the clinical outcomes of ex vivo liver resection and autotransplantation (ERAT) with allotransplantation in patients with end-stage hepatic alveolar echinococcosis (HAE). MethodsFrom January 2008 to October 2017, 41 of 254 patients with end-stage HAE fulfilled the inclusion criteria (ERAT group, n=35; allotransplantation group, n=6). Each group was assessed for indications and short- and long-term outcomes. ResultsThe intraoperative mortality was zero in both groups. Two patients died after ERAT due to intra-abdominal bleeding and acute cerebral hemorrhage. The most frequent postoperative complications were biliary complications, which occurred in six patients (14.6%). Parasite recurrence was recorded in two patients, at 16 months and 52 months after allotransplantation. The survival curve showed a longer survival time in the ERAT group than in the allotransplantation group (P=0.028). In the ERAT group, the 1-, 3-, and 5-year overall survival rates were all 100%. In the allotransplantation group, the 1-, 3-, and 5-year overall survival rates were 100%, 83.3%, and 66.7%, respectively. ConclusionsThis appears to be the first series comparing ERAT with allotransplantation for end-stage HAE. ERAT may be a superior alternative to allotransplantation in some cases, as it requires neither an organ donor nor immunosuppressive therapy.