Auxiliary Partial Liver Transplantation for End-Stage Chronic Liver Disease

Auxiliary heterotopic liver transplantation is theoretically attractive because it leaves the recipient's liver in place. The surgical trauma of hepatectomy is avoided, and failure of the graft does not necessarily lead to the death of the patient or a second, emergency transplantation. Another advantage is that matching the body sizes of the donor and the recipient is not mandatory, which increases the number of possible donors. However, previous clinical results of auxiliary liver transplantation have been poor. We performed auxiliary partial liver transplantation in six consecutive patients with end-stage chronic liver disease who were not accepted for orthotopic liver transplantation because they had massive ascites, deficient clotting function, cachexia, or poor pulmonary reserve. The donor liver was transplanted to the right subhepatic region after removal of segments II and III, and it was provided with portal and arterial blood. There were no major changes in hemodynamic measurements during surgery. The mean hospital stay after transplantation was 22.7 days (range, 14 to 29). After a mean follow-up period of 14 months (range, 5 to 23), all patients were alive, with good graft function as demonstrated by scintigraphy, Doppler ultrasonography, and synthesis of clotting factors. From these observations we conclude that auxiliary partial liver transplantation is an attractive alternative to orthotopic liver transplantation in high-risk patients. Its role in other patients who need liver transplants remains to be defined. (N Engl J Med 1988; 319:1507–11.) ORTHOTOPIC liver transplantation has become an accepted treatment for end-stage liver disease, but the procedure carries substantial early mortality and morbidity. 1 Auxiliary heterotopic liver transplantation is theoretically attractive because the recipient's liver is left in situ, thus avoiding the laborious removal of a cirrhotic liver, the associated blood loss, the subsequent period without a liver (the anhepatic phase), and the fall in cardiac output. The limitation of surgical trauma may result in a speedier recovery. The failure of the auxiliary graft does not necessarily lead to death or emergency retransplantation. In addition, the graft can be removed or left to . . .