Auxiliary Liver Transplantation for Acute Liver Failure in Children

作者：Faraj Walid; Dar Faisal; Bartlett Adam; Melendez Hector Vilca; Marangoni Gabriele; Mukherji Deborah; Vergani Georgina Mieli; Dhawan Anil; Heaton Nigel; Rela Mohamed^*

来源：Annals of Surgery, 2010, 251(2): 351-356.

DOI：10.1097/SLA.0b013e3181bdfef6

Objective: The aim of this study is to present the largest experience of auxiliary liver transplantation for acute liver failure (ALF) in children over the past 19 years.
Methods: Between 1990 and 2009, it total of 128 liver transplants were performed on children with ALF. Of these, 20 received auxiliary liver transplants (19 were cadaveric and 1 living graft). The recipient median age was 12 years (range: 1-16). Indications for auxiliary Partial orthotopic liver transplantation were seronegative non-A non-B hepatitis in 16 children, drug induced in 2, and I autoimmune hepatitis and I mushroom poisoning. The median waiting time for transplantation was 2 days (range: 1-9). After native liver partial hepatectomy, 20 grafts were implanted orthotopically and included 8 right lobes, 8 left lateral segments, 3 left lobes, and I whole liver. Regeneration of the native liver was assessed by radiologic, nuclear medicine imaging, and histology. Follow-up imaging and biopsies were performed at intervals of 3 to 6 months and yearly.
Results: Patient survival was 85% at 1, 5, and 10 years. There were 3 deaths at a median of 9 days (range: 8-52) post-transplantation. There was I retransplant for chronic rejection 15 months post-transplantation. There were no biliary or vascular complications. Of 17 survivors, 14 (821%) have Successfully regenerated their native liver and so far I I children (65% of the survivors) have been withdrawn from immunosuppression at a median time of 23 months (range: 4-106) after transplantation.
Conclusion: Auxiliary partial orthotopic liver transplantation should be considered in children presenting with ALF who fulfill criteria for liver transplantation.

• 出版日期2010-2