Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis
Author(s): ,
Hao Wen
Affiliations:
Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
Corresponding authors. Addresses: State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, China; Centre of Organ Transplantation, the First Affiliated Hospital of Xinj
,
Jie-Fu Huang
Affiliations:
Department of Hepatobiliary Surgery, Peking Union Medical College Hospital, Beijing, China
Corresponding authors. Addresses: State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, China; Centre of Organ Transplantation, the First Affiliated Hospital of Xinj
,
Yi-Biao He
Affiliations:
Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Rui-Qing Zhang
Affiliations:
Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Tie-Min Jiang
Affiliations:
Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Bo Ran
Affiliations:
Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Paizula Shalayiadang
Affiliations:
Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Tuerhongjiang Tuxun
Affiliations:
Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Tao Li
Affiliations:
Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Jin-Ming Zhao
Affiliations:
Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Ying-Mei Shao
Affiliations:
Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Jia-Hong Dong
Affiliations:
Department of Hepatobiliary Surgery, Beijing Tsinghua Chang Gung Hospital, Beijing. China
Tuerganaili Aji
Affiliations:
Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
EASL LiverTree™. Wen H. Nov 1, 2018; 234538
Hao Wen
Hao Wen
Contributions
Journal Abstract
References
Graphical abstract

Graphical abstract

Radical resection associated with albendazole is the best treatment for advanced hepatic alveolar echinococcosis. Liver transplantation is considered in selected advanced cases, although post-operative recurrence remains a risk. Present large series of ELRA describe a feasible surgical option, with 100% disease-free survival in survivors.

Background & Aims

Radical resection is the best treatment for patients with advanced hepatic alveolar echinococcosis (AE). Liver transplantation is considered for selected advanced cases; however, a shortage of organ donors and the risk of postoperative recurrence are major challenges. The aim of this study was to assess the clinical outcomes of ex vivo liver resection and autotransplantation for end-stage AE.

Methods

In this prospective study, 69 consecutive patients with end-stage hepatic AE were treated with ex vivo resection and liver autotransplantation between January 2010 and February 2017. The feasibility, safety and long-term clinical outcome of this technique were assessed.

Results

Ex vivo extended hepatectomy with autotransplantation was successful in all patients without intraoperative mortality. The median weight of the graft and AE lesion were 850 (370–1,600) g and 1,650 (375–5,000) g, respectively. The median duration of the operation and anhepatic phase were 15.9 (8–24) h and 360 (104–879) min, respectively. Six patients did not need any blood transfusion. Complications higher than IIIa according to Clavien classification were observed in 10 patients. The 30-day-mortality and overall mortality (>90 days) were 7.24% (5/69) and 11.5% (8/69), respectively. The mean hospital stay was 34.5 (12–128) days. Patients were followed-up systematically for a median of 22.5 months (14–89) without recurrence.

Conclusion

This is the largest series assessing ex vivo liver resection and autotransplantation in end-stage hepatic AE. This technique could be an effective alternative to liver transplantation in patients with end-stage hepatic AE, with the advantage that it does not require an organ nor immunosuppressive agents.

Lay summary

Ex vivo liver resection and autotransplantation were performed in a large series of patients with end-stage hepatic alveolar echinococcosis. The results showed that this surgical option was feasible, with acceptable postoperative mortality, but 100% disease-free survival in survivors. Careful patient selection, as well as precise assessment for size and quality of the remnant liver are key to successful surgery.

Keyword(s)
Hepatic alveolar echinococcosis, Hepatic resection, Transplantation, Hepatectomy, Immunosuppression
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