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 23 April 2018

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News

Indications for APOLT may need to be reconsidered

The indications for an auxiliary partial orthotopic liver transplantation procedure should be reconsidered in the light of the risks of technical complications and neurologic sequelae, according to research published in December's Annals of Surgery.

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Researchers from Villejuif, France, compared auxiliary partial orthotopic liver transplantation (APOLT) with standard whole-liver transplantation (OLT), in terms of postoperative death and complications, including neurologic sequelae.

In a consecutive series of 49 patients transplanted for fulminant or subfulminant hepatitis, 37 received OLT and 12 received APOLT.

APOLT was done when logistics allowed simultaneous performance of graft preparation and the native liver partial hepatectomy to revascularize the graft as soon as possible.

Each patient undergoing APOLT (12 patients) was matched to 2 patients undergoing OLT (24 patients) according to age, grade of coma, etiology, and fulminant or subfulminant type of hepatitis.

All grafts in the study population were retrieved from optimal donors.

In-hospital death occurred in 4 of 12 patients undergoing APOLT, compared with 6 of 24 patients undergoing OLT.

Patients receiving APOLT had a mean of 1 technical complication, compared with 0.3 for OLT patients.

Complication rate is higher with APOLT than OLT.
Annals of Surgery

The team found that bacteriemia was significantly more frequent after APOLT than after OLT.

In addition, the need for retransplantation was significantly higher in the APOLT patients (3/12 vs 0/24), and brain death from brain edema or neurologic sequelae was significantly more frequent (4/12 vs 2/24).

One-year patient survival was comparable in both groups (66% vs 66%). There was a trend toward lower 1-year retransplantation-free survival rates in the APOLT group (39% vs 66%).

Only 2 of 12 (17%) patients had full success with APOLT (i.e. patient survival, liver regeneration, withdrawal of immunosuppression, and graft removal). One of these two patients had neurologic sequelae.

Dr Daniel Azoulay, of the Hôpital Paul Brousse, said on behalf of the group, "Using optimal grafts, APOLT and OLT have similar patient survival rates. However, the complication rate is higher with APOLT.

"On an intent-to-treat basis, the efficacy of the APOLT procedure is low."

"This analysis suggests that the indications for an APOLT procedure should be reconsidered in the light of the risks of technical complications and neurologic sequelae," he concluded.

Ann Surg 2001; 234(6): 723-31
05 December 2001

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