Liver Transplantation in Patients with Post-Hepatectomy Liver Failure – A Northern European Multicenter Cohort Study

Abstract

Introduction: Post-hepatectomy liver failure (PHLF) remains a serious complication with frequently lethal consequences and treatment is mainly restricted to symptomatic support of vital functions. Orthtopic liver transplantation (OLT) has been described as a rescue treatment in severe, intractable PHLF, but is not considered to be indicated for this condition by many hepato-pancreato-biliary and transplant surgeons. Here we describe the clinical experience of five northern European tertiary centers in using OLT to treat selected patients with severe PHLF. Methods: All patients subjected to OLT due to PHLF at the participating centers were identified from prospective clinical databases. Preoperative variables, surgical outcome (both resection surgery and OLT) and follow-up data were assessed. Results: A total of 10 patients treated with OLT 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 OLT. Patients were followed for a median of 55 months (13-153) and all patients were alive at last follow-up, except one patient with colorectal liver metastases that recurred after 59 months and died at 78 months. Conclusion: In selected patients with PHLF OLT can be a life-saving procedure with low short-term risk. Special attention has to be paid to oncological long-term prognosis before proceeding with OLT in this setting.