A systematic review of auxiliary liver transplantation of small-for-size grafts in patients with chronic liver disease
Daniel Azoulay,
Cyrille Feray,
Chetana Lim,
Chady Salloum,
Maria Conticchio,
Daniel Cherqui,
Antonio Sa Cunha,
René Adam,
Eric Vibert,
Didier Samuel,
Marc Antoine Allard,
Nicolas Golse
Affiliations
Daniel Azoulay
Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, France; Corresponding author. Address: Centre Hépato-Biliaire, Hôpital Paul Brousse, 94000, Villejuif, France. Tel.: +33 1 45 59 30 49, fax: +33 1 45 59 38 57.
Cyrille Feray
INSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, France; Department of Hepatology, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
Chetana Lim
Department of Surgery, Pitié-Salpêtrière Hospital, Université Paris-Descartes, Paris, France
Chady Salloum
Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
Maria Conticchio
Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
Daniel Cherqui
Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, France
Antonio Sa Cunha
Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, France
René Adam
Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Unité 985, Villejuif, France
Eric Vibert
Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, France
Didier Samuel
INSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, France; Department of Hepatology, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
Marc Antoine Allard
Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Unité 985, Villejuif, France
Nicolas Golse
Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, France
Background & Aims: The shortage of liver grafts continues to worsen. Because the expanded use of small-for-size grafts (SFSGs) would substantially alleviate this shortage, we aimed to analyse the available knowledge on auxiliary liver transplantation (ALT) with SFSGs in patients with chronic liver disease (CLD) to identify opportunities to develop ALT with SFSGs in patients with CLD. Methods: This is a systematic review on ALT using SFSGs in patients with CLD. The review was completed by updates obtained from the authors of the retained reports. Results: Heterotopic ALT was performed in 26 cases between 1980 and 2017, none for SFGS stricto sensu, and auxiliary partial orthotopic liver transplantation (APOLT) in 27 cases (from 1999 to 2021), all for SFSG. In APOLT cases, partial native liver resection was performed in most of cases, whereas the second-stage remnant native liver hepatectomy was performed in 9 cases only. The median graft-to-body weight ratio was 0.55, requiring perioperative or intraoperative portal modulation in 16 cases. At least 1 complication occurred in 24 patients following the transplant procedure (morbidity rate, 89%). Four patients (4/27, 15%) died after the APOLT procedure. At the long term, 19 (70%) patients were alive and well at 13 months to 24 years (median, 4.5 years) including 18 with the APOLT graft in place and 1 following retransplantation. Conclusions: Despite high postoperative morbidity, and highly reported technical variability, the APOLT technique is a promising technique to use SFSGs in patients with CLD, achieving satisfactory long-term results. The results need to be confirmed on a larger scale, and a standardised technique could lead to even better results. Lay summary: At the cost of a high postoperative morbidity, the long-term results of APOLT for small-for-size grafts are good. Standardisation of the procedure and of portal modulation remain needed.
