Temporary heterotopic auxiliary liver transplantation for fulminant hepatitis B

Background/Aims: Orthotopic liver transplantation has been shown to improve survival in fulminant hepatic failure. However, after orthotopic liver transplantation life-long immunosuppression is necessary and graft complications may occur. Methods: We employed heterotopic auxiliary liver transplantation in a 26-year-old man with fulminant hepatic failure due to hepatitis B virus infection. Results: From a comatose state with seizures and decerebrate posturing, the patient woke up the day after heterotopic auxiliary liver transplantation. The graft functioned sufficiently. After 2 weeks, when peritonitis developed, immunosuppression was stopped since the native liver was recovering as shown by serial HIDA scans, liver biopsies, clotting parameters and serum bilirubin. When severe rejection of the graft developed 2 weeks later, and the peritonitis had been treated successfully, the native liver had recovered sufficiently to allow the graft to be removed. Now, more than 1 year after heterotopic auxiliary liver transplantation, the patient is free from medication and he is immune for hepatitis B virus, his liver tests have returned to normal and he has regained his normal life. Conclusions: Temporary heterotopic auxiliary liver transplantation for fulminant hepatitis B is feasible.