Learning objectives
To highlight the role of auxiliary liver transplantation as a bridge to native liver regeneration in treatment of acute liver failure.
To emphasize the role of CT volumetry and functional imaging (Hepatobiliary Imino diacetic acid (HIDA) scan) in guiding immunosuppression withdrawal in these patients.
Background
What is an APOLT ?
Auxiliary partial orthotopic liver transplantation (APOLT) is a surgical procedure performed for selective cases of acute liver failure in the paediatric age group. The nomenclature is self-explanatory and helps elucidate the steps involved in this unique surgical technique.
Auxiliary : defined as additional/ supplementary.
Current ex-vivo liver support devices fail remarkably in their attempt to replicate many of this organs’ diverse physiological functions following acute liver failure [1].
This role is however adequately taken up by the transplanted graft which...
Findings and procedure details
Baseline Contrast enhanced CT (CECT) and HIDA scans are performed at 4 weeks after an APOLT for volumetry and functional assessment respectively [5].
These are easily interpreted with the surgical technique in mind.
Post operative anatomy in a left lobe APOLT:
An extended left hepatectomy (includes removal of Middle hepatic vein) is performed in the recipient and right lobe parenchyma drained by the right hepatic vein remains.
Left lobe lateral segment graft is then implanted with vascular and biliary anastomoses [2]. (Figure 1)
Vascular anastomosis...
Conclusion
Immunosuppression was successfully completed in two patients and is ongoing in one child. Serial cross-sectional and functional liver imaging provide key information on weaning off immunosuppression in patients who receive an APOLT for acute liver failure.
Personal information and conflict of interest
A. Shankar; Chennai/IN - nothing to disclose D. S. Srinivas; Chennai/IN - nothing to disclose D. S. Kalyanasundaram; Chennai/IN - nothing to disclose D. M. S. Reddy; Chennai/IN - nothing to disclose M. Rela; Chennai/IN - nothing to disclose
References
O’Grady J. Personal view: current role of artificial liver support devices. Aliment Pharmacol Ther 2006;23:1549-1557.
Rela M, Kaliamoorthy I, Reddy MS. Current status of auxiliary partial orthotopic liver transplantation for acute liver failure.Liver transplantation: official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.2016;22(9):1265–74.
Quaglia A, Portmann BC, Knisely AS, Srinivasan P, Muiesan P, Wendon J, et al. Auxiliary transplantation for acute liver failure: Histopathological study of native liver regeneration. Liver Transpl 2008;14:1437-1448.
Faraj W, Dar F,...