Researchers from King's College Hospital in London, England, examined the benefits of auxiliary partial orthotopic liver transplantation (APOLT) for patients with acute liver failure.
In APOLT, the native liver is not removed when the donor liver is grafted.
The gradual withdrawal of immunosuppression after a partial orthotopic liver transplantation allows for the native liver to regenerate. Once that occurs, immunosuppression can be withdrawn.
These patients do not have to be on long-term immunosuppression. This means there is a good chance that they will avoid many problems faced by longer-term liver survivors who are on immunosuppression, such as tumors, kidney failure, and diabetes.
The researchers are clear in pointing out that this procedure is beneficial for a select group of patients.
According to Nigel David Heaton, who is in charge of the liver transplantation program, "APOLT is a technically more demanding procedure that cannot be performed on unstable patients."
A total of 30 patients have undergone APOLT at the authors' institution. Of these, 21 survived for more than 3 months post-transplant.
| APOLT allows for immunosuppression withdrawal and native liver regeneration.
Some 16 patients had evidence of native liver regeneration, 8 of which had been withdrawn completely from immunosuppression over a period of 6 to 24 months post-transplant.
Grafts atrophied in 7 of those patients following gradual immunosuppression withdrawal.
The last of the 16 abruptly stopped taking immunosuppression, resulting in the surgical excision of the graft.
The study stresses the need for immunosuppression to be gradually withdrawn.
"The two livers are engaged in a type of physiological competition," says Mr. Heaton.
"By gradually withdrawing immunosuppression, we are allowing for the native liver to regenerate."
The protocol for immunosuppression withdrawal that the researchers developed strikes the right balance needed to allow the transplanted liver to function and the native liver to regenerate.
"Avoiding the complications of long-term immunosuppression is especially important for a patient who is relatively young."