A systematic review of auxiliary liver transplantation of small-for-size grafts in patients with chronic liver disease
Background & Aims: The shortage of liver grafts continues to worsen. Because the expanded use of small-for-size grafts (SFSGs) would substantially alleviate this shortage, we aimed to analyse the available knowledge on auxiliary liver transplantation (ALT) with SFSGs in patients with chronic...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-04-01
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| Series: | JHEP Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589555922000192 |
| _version_ | 1828859076376788992 |
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| author | Daniel Azoulay Cyrille Feray Chetana Lim Chady Salloum Maria Conticchio Daniel Cherqui Antonio Sa Cunha René Adam Eric Vibert Didier Samuel Marc Antoine Allard Nicolas Golse |
| author_facet | Daniel Azoulay Cyrille Feray Chetana Lim Chady Salloum Maria Conticchio Daniel Cherqui Antonio Sa Cunha René Adam Eric Vibert Didier Samuel Marc Antoine Allard Nicolas Golse |
| author_sort | Daniel Azoulay |
| collection | DOAJ |
| description | Background & Aims: The shortage of liver grafts continues to worsen. Because the expanded use of small-for-size grafts (SFSGs) would substantially alleviate this shortage, we aimed to analyse the available knowledge on auxiliary liver transplantation (ALT) with SFSGs in patients with chronic liver disease (CLD) to identify opportunities to develop ALT with SFSGs in patients with CLD. Methods: This is a systematic review on ALT using SFSGs in patients with CLD. The review was completed by updates obtained from the authors of the retained reports. Results: Heterotopic ALT was performed in 26 cases between 1980 and 2017, none for SFGS stricto sensu, and auxiliary partial orthotopic liver transplantation (APOLT) in 27 cases (from 1999 to 2021), all for SFSG. In APOLT cases, partial native liver resection was performed in most of cases, whereas the second-stage remnant native liver hepatectomy was performed in 9 cases only. The median graft-to-body weight ratio was 0.55, requiring perioperative or intraoperative portal modulation in 16 cases. At least 1 complication occurred in 24 patients following the transplant procedure (morbidity rate, 89%). Four patients (4/27, 15%) died after the APOLT procedure. At the long term, 19 (70%) patients were alive and well at 13 months to 24 years (median, 4.5 years) including 18 with the APOLT graft in place and 1 following retransplantation. Conclusions: Despite high postoperative morbidity, and highly reported technical variability, the APOLT technique is a promising technique to use SFSGs in patients with CLD, achieving satisfactory long-term results. The results need to be confirmed on a larger scale, and a standardised technique could lead to even better results. Lay summary: At the cost of a high postoperative morbidity, the long-term results of APOLT for small-for-size grafts are good. Standardisation of the procedure and of portal modulation remain needed. |
| first_indexed | 2024-12-13T02:10:44Z |
| format | Article |
| id | doaj.art-ac7044efc8984e119811a854afea16c7 |
| institution | Directory Open Access Journal |
| issn | 2589-5559 |
| language | English |
| last_indexed | 2024-12-13T02:10:44Z |
| publishDate | 2022-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHEP Reports |
| spelling | doaj.art-ac7044efc8984e119811a854afea16c72022-12-22T00:03:02ZengElsevierJHEP Reports2589-55592022-04-0144100447A systematic review of auxiliary liver transplantation of small-for-size grafts in patients with chronic liver diseaseDaniel Azoulay0Cyrille Feray1Chetana Lim2Chady Salloum3Maria Conticchio4Daniel Cherqui5Antonio Sa Cunha6René Adam7Eric Vibert8Didier Samuel9Marc Antoine Allard10Nicolas Golse11Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, France; Corresponding author. Address: Centre Hépato-Biliaire, Hôpital Paul Brousse, 94000, Villejuif, France. Tel.: +33 1 45 59 30 49, fax: +33 1 45 59 38 57.INSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, France; Department of Hepatology, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, FranceDepartment of Surgery, Pitié-Salpêtrière Hospital, Université Paris-Descartes, Paris, FranceDepartment of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, FranceDepartment of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, FranceDepartment of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, FranceDepartment of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, FranceDepartment of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Unité 985, Villejuif, FranceDepartment of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, FranceINSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, France; Department of Hepatology, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, FranceDepartment of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Unité 985, Villejuif, FranceDepartment of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, FranceBackground & Aims: The shortage of liver grafts continues to worsen. Because the expanded use of small-for-size grafts (SFSGs) would substantially alleviate this shortage, we aimed to analyse the available knowledge on auxiliary liver transplantation (ALT) with SFSGs in patients with chronic liver disease (CLD) to identify opportunities to develop ALT with SFSGs in patients with CLD. Methods: This is a systematic review on ALT using SFSGs in patients with CLD. The review was completed by updates obtained from the authors of the retained reports. Results: Heterotopic ALT was performed in 26 cases between 1980 and 2017, none for SFGS stricto sensu, and auxiliary partial orthotopic liver transplantation (APOLT) in 27 cases (from 1999 to 2021), all for SFSG. In APOLT cases, partial native liver resection was performed in most of cases, whereas the second-stage remnant native liver hepatectomy was performed in 9 cases only. The median graft-to-body weight ratio was 0.55, requiring perioperative or intraoperative portal modulation in 16 cases. At least 1 complication occurred in 24 patients following the transplant procedure (morbidity rate, 89%). Four patients (4/27, 15%) died after the APOLT procedure. At the long term, 19 (70%) patients were alive and well at 13 months to 24 years (median, 4.5 years) including 18 with the APOLT graft in place and 1 following retransplantation. Conclusions: Despite high postoperative morbidity, and highly reported technical variability, the APOLT technique is a promising technique to use SFSGs in patients with CLD, achieving satisfactory long-term results. The results need to be confirmed on a larger scale, and a standardised technique could lead to even better results. Lay summary: At the cost of a high postoperative morbidity, the long-term results of APOLT for small-for-size grafts are good. Standardisation of the procedure and of portal modulation remain needed.http://www.sciencedirect.com/science/article/pii/S2589555922000192Organ shortageChronic liver diseaseLiver transplantationSmall-for-size graftSmall-for-size syndromeAuxiliary liver transplantation |
| spellingShingle | Daniel Azoulay Cyrille Feray Chetana Lim Chady Salloum Maria Conticchio Daniel Cherqui Antonio Sa Cunha René Adam Eric Vibert Didier Samuel Marc Antoine Allard Nicolas Golse A systematic review of auxiliary liver transplantation of small-for-size grafts in patients with chronic liver disease JHEP Reports Organ shortage Chronic liver disease Liver transplantation Small-for-size graft Small-for-size syndrome Auxiliary liver transplantation |
| title | A systematic review of auxiliary liver transplantation of small-for-size grafts in patients with chronic liver disease |
| title_full | A systematic review of auxiliary liver transplantation of small-for-size grafts in patients with chronic liver disease |
| title_fullStr | A systematic review of auxiliary liver transplantation of small-for-size grafts in patients with chronic liver disease |
| title_full_unstemmed | A systematic review of auxiliary liver transplantation of small-for-size grafts in patients with chronic liver disease |
| title_short | A systematic review of auxiliary liver transplantation of small-for-size grafts in patients with chronic liver disease |
| title_sort | systematic review of auxiliary liver transplantation of small for size grafts in patients with chronic liver disease |
| topic | Organ shortage Chronic liver disease Liver transplantation Small-for-size graft Small-for-size syndrome Auxiliary liver transplantation |
| url | http://www.sciencedirect.com/science/article/pii/S2589555922000192 |
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