Two‐stage liver transplantation: an effective procedure in urgent conditions

• Published in: Clinical transplantation Vol. 24; no. 1; pp. 122 - 126
• Main Authors: Montalti, Roberto, Busani, Stefano, Masetti, Michele, Girardis, Massimo, Di Benedetto, Fabrizio, Begliomini, Bruno, Rompianesi, Gianluca, Rinaldi, Laura, Ballarin, Roberto, Pasetto, Alberto, Gerunda, Giorgio E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-01-2010; Wiley
• Subjects: Adult; anhepatic state; Biological and medical sciences; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepatectomy; Humans; intensive care treatment; Liver Diseases - etiology; Liver Diseases - pathology; Liver Diseases - surgery; liver transplantation; Liver Transplantation - methods; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Portacaval Shunt, Surgical - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology; toxic liver syndrome; two‐stage hepatectomy; Intensive care; Digestive system; Toxicity; Liver; anhepatic state; Homotransplantation; Syndrome; Hepatectomy; Medicine; intensive care treatment; Clinical stage; Treatment; Efficiency; Surgery; State; toxic liver syndrome; Graft; Procedure; two-stage hepatectomy; Liver transplantation
• DOI: 10.1111/j.1399-0012.2009.01118.x
• EISSN: 1399-0012
• ISSN: 0902-0063

Montalti R, Busani S, Masetti M, Girardis M, Di Benedetto F, Begliomini B, Rompianesi G, Rinaldi L, Ballarin R, Pasetto A, Gerunda GE. Two‐stage liver transplantation: an effective procedure in urgent conditions.
Clin Transplant 2010: 24: 122–126. © 2009 John Wiley & Sons A/S.
:  Temporary portocaval shunt and total hepatectomy is a technique used in the presence of toxic liver syndrome because of fulminant hepatic failure, hepatic trauma, primary non‐function (PNF), and eclampsia. We performed this technique on four patients. An indication for anhepatic state was severe hemodynamic instability in three of them. Etiologies of these three patients were as follows: PNF after liver transplantation, ischemic hepatitis after right hepatic artery embolization, and massive reperfusion syndrome during a liver transplantation. In the fourth patient, during the liver transplantation when hepatic artery was ligated, a kidney carcinoma in the donor graft was discovered. We decided to complete the hepatectomy and to construct a temporary portocaval shunt.
Mean anhepatic phases were 19 h and 15 min. All patients survived the two‐stage liver transplantation procedure without major complications. Our cases demonstrated that temporary portocaval shunt while awaiting urgent liver transplantation could be an effective “bridge” in selected patients who develop toxic liver syndrome; however, a short time between portocaval shunt and transplantation and careful intensive care managements are mandatory.