Revisiting Auxiliary (APOLT) Transplantation in Children.

Area of Science:

• Hepatology
• Pediatric Surgery
• Regenerative Medicine

Background:

• Auxiliary partial orthotopic liver transplantation (APOLT) is an advanced strategy for pediatric acute liver failure (ALF) and non-cirrhotic metabolic liver diseases (NCMLD).
• Historically, technical challenges like portal steal limited APOLT's widespread adoption.
• APOLT offers unique benefits, including bridging to native liver regeneration or serving as a platform for gene therapy.

Purpose of the Study:

• To review the evolution, indications, technical refinements, and outcomes of APOLT in pediatric liver disease.
• To highlight advanced surgical techniques that have overcome previous limitations.
• To discuss the future potential of APOLT in conjunction with regenerative medicine.

Main Methods:

• Review of historical data and recent advancements in APOLT procedures.
• Analysis of surgical techniques, including portal flow modulation and anastomotic strategies.
• Examination of innovative approaches like domino-auxiliary procedures and robotic APOLT.

Main Results:

• Technical refinements have successfully mitigated risks such as portal steal, leading to outcomes comparable to standard liver transplantation.
• Advanced techniques and innovations like robotic APOLT demonstrate significant technical progress.
• APOLT is increasingly recognized for its role in bridging patients to curative regenerative therapies.

Conclusions:

• APOLT has evolved into a viable and sophisticated therapeutic option for select pediatric liver conditions.
• Future advancements in regenerative medicine, particularly gene editing, hold promise for definitive cures when combined with APOLT.
• Dissemination of surgical expertise through global collaboration is crucial for realizing APOLT's full potential.