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Rescue hepatectomy for initial graft non-function after liver transplantation
K J Oldhafer1, A Bornscheuer, N R Frühauf
1Klinik für Abdominal und Transplantationschirurgie, Medizinische Hochschule, Hannover, Germany.
Transplantation
|April 30, 1999
Summary
Early liver retransplantation is crucial for initial graft nonfunction (INF). In severe cases, hepatectomy and temporary shunt stabilize patients, proving effective for life-saving liver retransplantation.
Area of Science:
- Hepatology
- Transplantation Surgery
- Critical Care Medicine
Background:
- Initial graft nonfunction (INF) following liver transplantation necessitates early retransplantation.
- A subset of patients with INF develop severe cardiovascular and/or pulmonary insufficiency, posing a life-threatening risk while awaiting retransplantation.
- A two-stage approach involving graft removal, temporary portocaval shunt, and subsequent retransplantation has been explored for these complex cases.
Purpose of the Study:
- To report the experience and outcomes of a two-stage hepatectomy and subsequent liver transplantation in patients with INF complicated by severe cardiorespiratory instability.
- To evaluate the efficacy of graft removal and temporary shunting in stabilizing critically ill patients awaiting liver retransplantation.
Main Methods:
- Hepatectomy was performed in 20 patients with INF and severe cardiovascular/pulmonary insufficiency awaiting emergency retransplantation.
- The mean age of patients was 41.75 years, with hepatectomy occurring 2.8 days post-primary transplant on average.
Main Results:
- Hepatectomy led to improved cardiovascular and pulmonary function in most patients, reducing the need for vasopressors.
- Four patients died before retransplantation; of the 16 who underwent retransplantation, 2 died early postoperatively.
- Seven of the 16 retransplanted patients achieved long-term survival, while 7 died between 13 and 105 days, primarily due to sepsis.
Conclusions:
- Hepatectomy effectively stabilizes cardiovascular and pulmonary function in patients with INF and critical instability.
- This two-stage procedure of hepatectomy followed by liver retransplantation is a beneficial, life-saving intervention for select patients with complicated INF.