Transplant Hepatectomy With Portacaval Shunt and MARS Therapy for Perioperative Catastrophe: A Series of Four Liver Transplant Cases
Hanish, Steven I
Bruno, David A
Hutson, William R
Stein, Deborah M
Barth, Rolf N
LaMattina, John C
PublisherWolters Kluwer Health
MetadataShow full item record
AbstractIncreased worldwide focus on maximal donor utilization and transplantation of patients once considered too ill to survive liver transplantation may increase the otherwise rare frequency of catastrophic graft failure. Although the deleterious effects of an acutely failing allograft have been established for decades, the optimal strategy in this patient population in the perioperative period remains ill-defined. Methods: A retrospective review of all liver transplant recipients with perioperative failure leading to transplant hepatectomy between January 1, 2014 and June 30, 2017 was performed. All patients were supported with MARS therapy while awaiting retransplantation. Results: Four patients experienced catastrophic graft failure from massive exsanguination and liver fracture (1), portal vein and hepatic artery thrombosis (1), idiopathic necrosis (1), and necrosis from inadequate donor flushing/primary nonfunction (1). All patients improved following transplant hepatectomy with portacaval shunting. Patients were supported with intubation, vasopressors, renal replacement therapy, and Molecular Adsorbent Recirculating System therapy. All patients underwent retransplantation after a mean anhepatic phase of 48.8 (± 5.13) h. Survival to discharge was 75%. Conclusions: Although catastrophic liver failure is highly challenging, acceptable outcomes can be achieved with timely hepatectomy with portacaval shunt and retransplantation, particularly in patients supported with the Molecular Adsorbent Recirculating System device.
Rights/TermsCopyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.
Keywordmolecular absorbent recirculating system (MARS)
transplant hepatectomy with portacaval shunt
Liver Transplantation--adverse effects
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/16060
- Long-term survival after 67 hours of anhepatic state due to primary liver allograft nonfunction.
- Authors: Arora H, Thekkekandam J, Tesche L, Sweeting R, Gerber DA, Hayashi PH, Andreoni K, Kozlowski T
- Issue date: 2010 Dec
- To transplant or not to transplant recurrent hepatitis C and liver failure.
- Authors: Forman LM
- Issue date: 2003 Aug
- Continuous venovenous hemofiltration with dialysis in combination with total hepatectomy and portocaval shunting. Bridge to liver transplantation.
- Authors: Hammer GB, So SK, Al-Uzri A, Conley SB, Concepcion W, Cox KL, Berquist WE, Esquivel CO
- Issue date: 1996 Jul 15
- Intensive care during prolonged anhepatic state after total hepatectomy and porto-caval shunt (two-stage procedure) in surgical complications of liver transplantation.
- Authors: Bustamante M, Castroagudín JF, Gonzalez-Quintela A, Martinez J, Segade FR, Fernandez A, Galban C, Varo E
- Issue date: 2000 Sep-Oct
- Prolonged anhepatic state after early liver graft removal.
- Authors: Detry O, De Roover A, Delwaide J, Hans MF, Canivet JL, Meurisse M, Honoré P
- Issue date: 2007 Oct-Nov