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Laparoscopic Anatomical Liver Segment VII Resection with Liver Parenchymal Transection Following a Priority Approach
Published on: May 23, 2025
Liver resection in liver transplant recipients
Gabriele Marangoni1, Walid Faraj, Harsheet Sethi
1King's College London School of Medicine at King's College Hospital, Institute of Liver Studies, Denmark Hill, SE59RS London, UK.
Hepatobiliary & Pancreatic Diseases International : HBPD INT
|December 17, 2008
Summary
Liver resection after liver transplantation is a safe procedure for selected patients, potentially avoiding re-transplantation. While outcomes are generally good, recurrent hepatocellular carcinoma (HCC) in the graft has a low cure rate.
Area of Science:
- Hepatobiliary surgery
- Transplant surgery
- Gastroenterology
Background:
- Liver resection post-liver transplantation is uncommon.
- Indications include hepatic artery thrombosis (HAT), biliary strictures, abscess, trauma, and hepatocellular carcinoma (HCC) recurrence.
- Graft salvage attempts are driven by organ shortage and lower re-transplantation survival rates.
Purpose of the Study:
- To evaluate the safety and outcomes of liver resection in liver transplant recipients.
- To assess the potential for graft salvage and avoidance of re-transplantation.
Main Methods:
- A retrospective review of 11 liver resections performed at least 59 months post-liver transplantation over 18 years.
- Indications included HCC recurrence (4), ischemic cholangiopathy (2), segmental HAT (2), sepsis (2), infected hematoma (2), and ischemic segment IV (1).
Main Results:
- No perioperative mortality observed.
- Morbidity included re-laparotomy for bowel perforation, bile leak, subphrenic collection, wound infection, and Gram-negative sepsis.
- Three deaths occurred due to HCC recurrence (2) and post-transplant lymphoproliferative disorder (1); one patient required re-transplantation.
Conclusions:
- Liver resection in liver transplant recipients is safe with good outcomes in selected cases.
- Resection can avoid re-transplantation for the majority of patients.
- Recurrent HCC in the graft may benefit from resection, but achieving a cure is uncommon.
