Total hepatectomy and liver transplantation: a life-saving procedure in patients with severe hepatic trauma.

Management of blunt hepatic trauma has been refined recently and now ranges from non-operative measures to the use of extensive surgical techniques. A consecutive series of eight patients was treated by total hepatectomy, either with a temporary portacaval shunt as a bridging procedure (since no donor liver was available immediately; six patients) or followed by standard liver transplantation (two). Previous operations included perihepatic packing, deep suturing, partial liver resection and hepatic artery ligation, and were attended by severe complications, namely uncontrollable bleeding (four patients) and massive liver necrosis (four). Six of the eight patients died from multiorgan failure or sepsis, and two recipients are alive 49 and 67 months after two-stage hepatectomy and transplantation. This experience demonstrates that total hepatectomy can be a life-saving procedure in exceptional emergencies in patients with potentially lethal hepatic trauma. The prognosis is dependent not only on the severity of liver injury but also on the complications of primary treatment.