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Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end‐stage hepatic alveolar echinococcosis: A study of 31 cases
Author(s) -
Yang Xianwei,
Qiu Yiwen,
Huang Bin,
Wang Wentao,
Shen Shu,
Feng Xi,
Wei Yonggang,
Lei Jianyong,
Zhao Jichun,
Li Bo,
Wen Tianfu,
Yan Lunan
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14621
Subject(s) - medicine , autotransplantation , surgery , echinococcosis , alveolar echinococcosis , stage (stratigraphy) , ex vivo , liver transplantation , resection , transplantation , in vivo , paleontology , microbiology and biotechnology , biology
Ex vivo liver resection combined with autotransplantation is a recently introduced approach to cure end‐stage hepatic alveolar echinococcosis ( HAE ), which is considered unresectable by conventional radical resection due to echinococcal dissemination into the crucial intrahepatic conduits and adjacent structures. This article aims discuss the manipulation details and propose reasonable indications for this promising technique. All patients successfully underwent liver autotransplantation with no intraoperative mortality. The median weight of the autografts was 636 g (360‐1300 g), the median operation time was 12.5 hours (9.4‐19.5 hours), and the median anhepatic phase was 309 minutes (180‐ 460 minutes). Intraoperative blood loss averaged 1800 mL (1200‐6000 mL ). Postoperative complications occurred in 13 patients during hospitalization; 5 patients experienced postoperative complications classified as Clavien‐Dindo grade III or higher, and 2 patients died of intraabdominal bleeding and acute cerebral hemorrhage, respectively. Twenty‐nine patients were followed for a median of 14.0 months (3‐42 months), and no HAE recurrence was detected. The technique requires neither an organ donor nor any postoperative immunosuppressant, and the success of the treatment relies on meticulous preoperative assessments and precise surgical manipulation.