NIV Congres

Introduction Auxiliary liver transplantation (AXLT) is an attractive alternative to orthotopic liver transplantation (OLT) in patients with acute liver failure (ALF). In the acute setting the auxiliary graft is expected to act as a bridge to recovery of the own liver.

Methods All AXLTs and OLTs performed for ALF in our center between September 1992 and June 2012 were analysed retrospectively. Donor-, recipient- and transplant factors were evaluated. We looked at patient death, need for re-transplantation and withdrawal of immunosuppressive therapy.

Results A total of 13 AXLTs (10 after 2002) and 10 OLTs (2 after 2002) for ALF were performed in our center. For AXLT donors were younger (median age 34 years) and liver allografts were transplanted into younger recipients (median age 37 years). Most frequent cause of ALF was acute hepatitis B (N=6). One-year patient survival was 7/13 (54%) for AXLT and 7/10 (70%) for OLT (p<0.01). Out of the 7 AXLT survivors 5 (71%) are off all immunosuppression (4 after removal of the graft, in one immunosuppression was slowly withdrawn with deliberate chronic rejection of the graft). In 4 cases the auxiliary graft was re-used for OLT in a cirrhotic patient. Of the 13 AXLT-patients 2 underwent an orthotopic re-transplantation (reOLT) after 6 and 8 days for primary non-function of the graft. Of OLT-patients 2 underwent reOLT, but later, after 3 and 6 years for hepatic artery thrombosis and chronic rejection respectively. All four reOLT patients are alive. All patients who died did so within the first month after transplantation. Primary nonfunction and/or vascular problems were present in 7/13 AXLT (1reOLT alive, 6 died), and in 0/10 OLTs (p<0.01).

Conclusion Patient- and graftsurvival was better after OLT than after AXLT for ALF, mainly due to PNF and vascular problems after AXLT, while 71% of surviving patients after AXLT were off all immunosuppression. Better patient selection and further technical improvements may further improve AXLT results. However, validation of these findings in a larger patient cohort is warranted before final conclusions can be drawn.