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Liver resection in liver transplant recipients |
Gabriele Marangoni, Walid Faraj, Harsheet Sethi, Mohamed Rela, Paolo Muiesan and Nigel Heaton |
London, UK
Author Affiliations: Kings College London School of Medicine at Kings College Hospital, Institute of Liver Studies, Denmark Hill, SE5 9RS, London, UK (Marangoni G, Faraj W, Sethi H, Rela M and Heaton N); University Hospital Birmingham, Edgbaston, B15 2TH, Birmingham, UK (Muiesan P)
Corresponding Author: Nigel Heaton, Professor, Institute of Liver Studies, Kings College Hospital, Denmark Hill, SE5 9RS, London, UK (Tel: +44-2032993672; Fax: +44-2032993575; Email: Nigel.Heaton@kch.nhs.uk) |
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Abstract BACKGROUND: Liver resection after liver transplantation is a relatively uncommon procedure. Indications for liver resection include hepatic artery thrombosis (HAT), non-anastomotic biliary stricture (ischemic biliary lesions), liver abscess, liver trauma and recurrence of hepatocellular carcinoma (HCC). Organ shortage and lower survival after re-transplantation have encouraged us to make attempts at graft salvage.
METHODS: Eleven resections at a mean of 59 months after liver transplantation were made over 18 years. Indications for liver resection included HCC recurrence in 4 patients, ischemic cholangiopathy, segmental HAT, sepsis and infected hematoma in 2 each, and ischemic segment Ⅳ after split liver transplantation in 1.
RESULTS: There was no perioperative mortality. Morbidity included one re-laparotomy for small bowel perforation, one bile leak treated conservatively, one right subphrenic collection, one wound infection and 5 episodes of Gram-negative sepsis. One patient underwent re-transplantation 4 months after resection for chronic rejection. There were 3 deaths, two from HCC recurrence and one from post-transplant lymphoproliferative disorder. The overall mean follow-up after resection was 48 months.
CONCLUSIONS: Liver resection in liver transplant recipients is safe, and has good outcome in selected patients and avoids re-transplantation in the majority of patients. Recipients with recurrent HCC in graft may benefit from resection, but cure is uncommon.
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