Left Lobe Auxiliary Liver Transplantation for End‐stage Hepatitis B Liver Cirrhosis

• Published in: American journal of transplantation Vol. 17; no. 6; pp. 1606 - 1612
• Main Authors: Wang, S.‐F., Chen, X.‐P., Chen, Z.‐S., Wei, L., Dong, S.‐L., Guo, H., Jiang, J.‐P., Teng, W.‐H., Huang, Z.‐Y., Zhang, W.‐G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01-06-2017
• Subjects: Adult; Antigens; Antiviral drugs; Biopsy; clinical research/practice; Female; Follow-Up Studies; Graft Survival; Hepatitis; Hepatitis B; Hepatitis B - complications; Hepatitis B - virology; Hepatitis B virus - isolation & purification; Humans; Immunology; Immunosuppression; Liver cirrhosis; Liver Cirrhosis - etiology; Liver Cirrhosis - surgery; Liver transplantation; Liver Transplantation - methods; liver transplantation/hepatology; liver transplantation: auxiliary; liver transplantation: living donor; liver transplantation: split; Liver transplants; Male; Middle Aged; Prognosis; Risk Factors; Transplants & implants; liver transplantation: living donor; liver transplantation: split; liver transplantation/hepatology; clinical research/practice; liver transplantation: auxiliary
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.14143

Auxiliary liver transplantation (ALT) for hepatitis B virus (HBV)‐related liver cirrhosis previously showed poor results, because the native liver was a significant source of HBV recurrence and the graft could be rapidly destroyed by HBV infection in an immunosuppressive condition. Four patients with HBV‐related liver cirrhosis were unable to undergo orthotopic liver transplantation because the only available grafts of left lobe were too small. Under entecavir‐based anti‐HBV treatment, they underwent ALT in which the recipient left liver was removed and the small left lobe graft was implanted in the corresponding space. The mean graft weight/recipient weight was 0.49% (range, 0.38%–0.55%). One year after transplantation, the graft sizes were increased to 273% and the remnant livers were decreased to 44%. Serum HBV DNA was persistently undetectable. Periodic graft biopsy showed no signs of tissue injury and negative immunostaining for hepatitis B surface antigen and hepatitis B core antigen. After a mean follow‐up period of 21 months, all patients live well with normal graft function. Our study suggests that ALT for HBV‐related liver cirrhosis is feasible under entecavir‐based anti‐HBV treatment. Successful application of small left livers in end‐stage liver cirrhosis may significantly increase the pool of left liver grafts for adult patients.
In patients with end‐stage hepatitis B liver cirrhosis who receive left lobe auxiliary liver transplants and are treated with entecavir, auxiliary small liver grafts regenerate well and are not infected by the hepatitis B virus, thus expanding the use of left livers.