Abstract
Liver transplantation (LTX) has been described as a rescue treatment option in severe, intractable post-hepatectomy liver failure (PHLF), but is not considered to be indicated for this condition by many hepatobiliary and transplant surgeons. In this article we describe the clinical experience of five northern European tertiary centers in using LTX to treat selected patients with severe PHLF. All patients subjected to LTX due to PHLF at the participating centers were identified from prospective clinical databases. Preoperative variables, surgical outcome (both resection surgery and LTX) and follow-up data were assessed. A total of 10 patients treated with LTX due to severe PHLF from September 2008 to May 2020 were identified and included in the study. All patients but one were male and the median age was 70 years (range 49-72). In all patients the indication for liver resection was suspected malignancy, but in six patients post-resection pathology revealed benign or pre-malignant disease. There was no 90-day mortality after LTX. Patients were followed for a median of 49 months (13-153) and eight patients were alive without recurrence at last follow-up. In selected patients with PHLF LTX can be a life-saving procedure with low short-term risk.
Highlights
Orthotopic liver transplantation (LTX) is an established procedure in the treatment of patients with acute or chronic liver failure.[1]
In this study we aim to present a northern European multicenter experience with the selective use of LTX to treat patients with severe post-hepatectomy liver failure (PHLF)
Inclusion criteria was liver transplantation due to PHLF based on the criteria stated by the International Study Group for Liver Surgery (ISGLS)[13] within 3 months following hepatectomy
Summary
Orthotopic liver transplantation (LTX) is an established procedure in the treatment of patients with acute or chronic liver failure.[1]. PHLF is the single most important complication contributing to 90-day mortality following major hepatectomy.[9,10] Once severe PHLF occurs there is no effective treatment available, and current clinical management consists of treating underlying infections and support vital organ functions.[11] For the most severe forms of PHLF, mortality rates at 60 and 90 days after liver resections were reported as high as 59% and 54% respectively for specific definitions of PHLF.[12,13] For this reason, LTX is occasionally considered for this patient group, but mostly abandoned since most patients have been operated for primary or secondary hepatobiliary malignancies, which in many countries excludes them from being offered LTX. We want to raise the question and discuss whether this treatment should be more readily used for this indication
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