There are no studies comparing the long-term survival after heterotopic liver transplantation and orthotopic liver transplantation for chronic liver disease.
Dr de Rave and colleagues from the Netherlands performed heterotopic liver transplantation in 17 patients with chronic liver disease between 1986 and 1990.
In spite of theoretical advantages and favorable short-term results, the researchers abandoned heterotopic liver transplantation because of doubts about the long-term outcome and the improved results of standard orthotopic liver transplantation.
The investigators performed a case-control study of heterotopic liver transplantation versus orthotopic liver transplantation.
The study provided data from amongst the largest single-center series of heterotopic liver transplantations available.
Long-term outcome of heterotopic liver transplantation was inferior to orthotopic liver transplantation|
The investigative team considered long-term patient and graft survival as the main outcome measures.
The team corrected for known confounders and differences in baseline characteristics between heterotopic liver transplantation and orthotopic liver transplantation patients.
At 1 year, 5 of the 17 heterotopic liver transplantation patients had died, compared with 9 of the 34 orthotopic liver transplantation patients.
After the researchers corrected for confounders, the long-term risk of graft failure and of death was higher after heterotopic liver transplantation than after orthotopic liver transplantation.
In addition, the team showed that the main causes of graft loss and death at more than 1 year after heterotopic liver transplantation were de novo malignancies and a variety of biliary complications.
The research team found no significant difference between heterotopic liver transplantation and orthotopic liver transplantation in 1 year survival.
However, the long-term outcome of heterotopic liver transplantation was inferior to orthotopic liver transplantation.
Dr de Rave concludes, “Heterotopic liver transplantation cannot be recommended as an alternative to orthotopic liver transplantation for any of the indications we studied."
"We make this recommendation even though only 1 of the late deaths was definitely related to the heterotopic technique.”