Simplified technique for auxiliary orthotopic liver transplantation using a whole graft.

Vinicius Rocha-Santos,Lucas Souto Nacif,Rafael Soares Pinheiro,Liliana Ducatti,Luiz Carneiro D'Alburquerque,Wellington Andraus

doi:10.1590/s0102-67202015000200013

Abstract

BackgroundAcute liver failure is associated with a high mortality rate and the main purposes of treatment are to prevent cerebral edema and infections, which often are responsible for patient death. The orthotopic liver transplantation is the gold standard treatment and improves the 1-year survival.AimTo describe an alternative technique to auxiliary liver transplant on acute liver failure.MethodWas performed whole auxiliary liver transplantation as an alternative technique for a partial auxiliary liver transplantation using a whole liver graft from a child removing the native right liver performed a right hepatectomy. The patient met the O´Grady´s criteria and the rational to indicate an auxiliary orthotopic liver transplantation was the acute classification without hemodynamic instability or renal failure in a patient with deterioration in consciousness.ResultsThe procedure improved liver function and decreased intracranial hypertension in the postoperative period.ConclusionThis technique can overcome some postoperative complications that are associated with partial grafts. As far as is known, this is the first case of auxiliary orthotopic liver transplantation in Brazil.

Highlights

Acute liver failure is associated with a high mortality rate and the main purposes of treatment are to prevent cerebral edema and infections, which often are responsible for patient death[1]
Auxiliary partial orthotopic liver transplantation is the main style of Auxiliary liver transplantation (ALT) and it consists in reducing or splitting the graft to fit the graft in the abdominal cavity
The objective of this study is to present surgical technique, describing an alternative technique for this novel procedure of ALT in acute liver failure using a whole graft

Summary

Introduction

Acute liver failure is associated with a high mortality rate and the main purposes of treatment are to prevent cerebral edema and infections, which often are responsible for patient death[1]. Auxiliary liver transplantation (ALT) is an accepted modality for selected recipients with ALF5. There are three described techniques: heterotopic ALT, auxiliary partial orthotopic liver transplantation and whole graft ALT. Auxiliary partial orthotopic liver transplantation is the main style of ALT and it consists in reducing or splitting the graft to fit the graft in the abdominal cavity. Auxiliary partial orthotopic liver transplantation requires hepatic parenchyma transection imposing longer ischemia time. The objective of this study is to present surgical technique, describing an alternative technique for this novel procedure of ALT in acute liver failure using a whole graft

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