Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis
Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis
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DOI：
10.1016/j.jhep.2018.07.006
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发表时间：
2018-11-01
影响因子：
25.7
通讯作者：
Wen, Hao
中科院分区：
文献类型：
--
作者：
Aji, Tuerganaili;Dong, Jia-Hong;Wen, Hao
背景与目的：根治性切除术是治疗晚期肝泡状棘球蚴病（AE）的最佳方法。肝移植被认为是对某些晚期病例的治疗;然而，器官供体短缺和术后复发的风险是主要挑战。本研究的目的是评估离体肝切除术和自体肝移植治疗终末期AE.Methods的临床结局：在这项前瞻性研究中，69例连续终末期肝脏AE患者在2010年1月至2017年2月期间接受离体肝切除术和自体肝移植治疗。该技术的可行性，安全性和长期的临床outcome进行了assessed.Results：离体扩大肝切除术与自体移植是成功的，在所有患者无术中死亡。移植物和AE病变的中位重量分别为850（370- 1，600）g和1，650（375- 5，000）g。中位手术时间和无肝期时间分别为15.9（8-24）h和360（104-879）min。6例患者不需要输血。根据Clavien分类，在10例患者中观察到高于IIIa的并发症。30天死亡率为7.24%（5/69），总死亡率（> 90天）为11.5%（8/69）。平均住院时间为34.5（12-128）天。患者进行了系统的随访，中位数为22.5个月（14-89）没有recursion.Conclusion：这是最大的系列评估离体肝切除术和自体移植在终末期肝AE。该技术可能是终末期肝脏AE患者肝移植的有效替代方法，其优点是不需要器官或免疫抑制剂。(C)2018由Elsevier B. V.代表欧洲肝脏研究协会发表。
Background & Aims: Radical resection is the best treatment for patients with advanced hepatic alveolar echinococcosis (AE). Liver transplantation is considered for selected advanced cases; however, a shortage of organ donors and the risk of postoperative recurrence are major challenges. The aim of this study was to assess the clinical outcomes of ex vivo liver resection and autotransplantation for end-stage AE.Methods: In this prospective study, 69 consecutive patients with end-stage hepatic AE were treated with ex vivo resection and liver autotransplantation between January 2010 and February 2017. The feasibility, safety and long-term clinical outcome of this technique were assessed.Results: Ex vivo extended hepatectomy with autotransplantation was successful in all patients without intraoperative mortality. The median weight of the graft and AE lesion were 850 (370-1,600) g and 1,650 (375-5,000) g, respectively. The median duration of the operation and anhepatic phase were 15.9 (8-24) h and 360 (104-879) min, respectively. Six patients did not need any blood transfusion. Complications higher than IIIa according to Clavien classification were observed in 10 patients. The 30-day-mortality and overall mortality (> 90 days) were 7.24% (5/69) and 11.5% (8/69), respectively. The mean hospital stay was 34.5 (12-128) days. Patients were followed-up systematically for a median of 22.5 months (14-89) without recurrence.Conclusion: This is the largest series assessing ex vivo liver resection and autotransplantation in end-stage hepatic AE. This technique could be an effective alternative to liver transplantation in patients with end-stage hepatic AE, with the advantage that it does not require an organ nor immunosuppressive agents. (C) 2018 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.