AIM: To evaluate the outcomes of two-stage liver transplant at a single institution, between 1993 and March 2015. METHODS: We reviewed our institutional experience with emergency hepatectomy followed by transplantation for fulminant liver failure over a twenty-year period. A retrospective review of a prospectively maintained liver transplant database was undertaken at a national liver transplant centre. Demographic data, clinical presentation, preoperative investigations, cardiocirculatory parameters, operative and postoperative data were recorded. RESULTS: In the study period, six two-stage liver transplants were undertaken. Indications for transplantation included acute paracetamol poisoning (n = 3), fulminant hepatitis A (n = 1), trauma (n = 1) and exertional heat stroke (n = 1). Anhepatic time ranged from 330 to 2640 min. All patients demonstrated systemic inflammatory response syndrome in the first post-operative week and the incidence of sepsis was high at 50%. There was one mortality, secondary to cardiac arrest 12 h following re-perfusion. Two patients required re-transplantation secondary to arterial thrombosis. At a median follow-up of 112 mo, 5 of 6 patients are alive and without evidence of graft dysfunciton. CONCLUSION: Two-stage liver transplantation represents a safe and potentially life-saving treatment for carefully selected exceptional cases of fulminant hepatic failure.
AIM: To evaluate the outcomes of two-stage liver transplant at a single institution, between 1993 and March 2015. METHODS: We reviewed our institutional experience with emergency hepatectomy followed by transplantation for fulminant liver failure over a twenty-year period. A retrospective review of a prospectively maintained liver transplant database was undertaken at a national liver transplant centre. Demographic data, clinical presentation, preoperative investigations, cardiocirculatory parameters, operative and postoperative data were recorded. RESULTS: In the study period, six two-stage liver transplants were undertaken. Indications for transplantation included acute paracetamolpoisoning (n = 3), fulminant hepatitis A (n = 1), trauma (n = 1) and exertional heat stroke (n = 1). Anhepatic time ranged from 330 to 2640 min. All patients demonstrated systemic inflammatory response syndrome in the first post-operative week and the incidence of sepsis was high at 50%. There was one mortality, secondary to cardiac arrest 12 h following re-perfusion. Two patients required re-transplantation secondary to arterial thrombosis. At a median follow-up of 112 mo, 5 of 6 patients are alive and without evidence of graft dysfunciton. CONCLUSION: Two-stage liver transplantation represents a safe and potentially life-saving treatment for carefully selected exceptional cases of fulminant hepatic failure.
Authors: K J Oldhafer; A Bornscheuer; N R Frühauf; M K Frerker; H J Schlitt; B Ringe; R Raab; R Pichlmayr Journal: Transplantation Date: 1999-04-15 Impact factor: 4.939
Authors: G B Hammer; S K So; A Al-Uzri; S B Conley; W Concepcion; K L Cox; W E Berquist; C O Esquivel Journal: Transplantation Date: 1996-07-15 Impact factor: 4.939
Authors: J Rozga; L Podesta; E LePage; A Hoffman; E Morsiani; L Sher; G M Woolf; L Makowka; A A Demetriou Journal: Lancet Date: 1993-10-09 Impact factor: 79.321
Authors: H M Heneghan; F Nazirawan; D Dorcaratto; B Fiore; J F Boylan; D Maguire; E Hoti Journal: Transplant Proc Date: 2014-07-03 Impact factor: 1.066
Authors: Michael J Guirl; Jeffrey S Weinstein; Robert M Goldstein; Marlon F Levy; Goran B Klintmalm Journal: Liver Transpl Date: 2004-04 Impact factor: 5.799