Transplantation and autotransplantation of the liver in radical treatment of unresectable liver tumors and parasitic diseases

Abstract

Aim. To evaluate results of liver transplantation and ex situ liver resection and autotransplantation in patients with unresectable parasitic and tumor liver lesions. Matherial and methods. A total of 22 orthotopic liver transplants and 4 ex situ liver resection and autotransplantations were performed. Liver transplants performed in 10 cases of unresectable hepatocellular carcinoma, 8 cases of alveolar echinococcosis, 4 cases of hepatic epithelioid haemangioendothelioma. Ex situ liver resection and autotransplantation were performed in 3 cases of alveolar echinococcosis and in 1 case of cholangiocarcinoma. Results. Postoperative complication developed in 38,4% patients. Mortality rate was 19.2%. Patients with alveolar echinococcosis were most complicated group with 36,3% early mortality rate. Mortality in hepatocellular carcinoma group was 10%. There were no early mortality in haemangioendothelioma and cholangiocarcinoma patients. Median overall survival for hepatocelluler carcinoma, alveolar echinococcosis and hepatic epithelioid haemangioendothelioma groups was 48, 36, 20 months respectively. Patient after ex situ liver resection for cholangiocarcinoma alive for 24 months and still disease free. Conclusion. Liver transplantation and ex situ liver resection and autotransplantation is the only opportunity for radical treatment for unresectable alveolar echinococcosis and some oncological diseases of the organ. Patients with unresectable alveolar echinococcosis is a high risk group of postoperative complications due to initial poor physical status, long-time disease, chronically infections and parasitic invasion.