RT Book, Section
A1 Ruffolo, Luis I.
A1 Nghiem, Bao Tram
A1 Linehan, David C.
A1 Tomiyama, Koji
A1 Hernandez-Alejandro, Roberto
A2 Molmenti, Ernesto Pompeo
A2 Santibañes, Martin de
A2 Santibañes, Eduardo de
SR Print(0)
ID 1178710198
T1 The RAPID Concept: Pushing the Boundary in Resectability in Liver Transplant Oncology
T2 Liver Transplantation: Operative Techniques and Medical Management
YR 2021
FD 2021
PB McGraw Hill
PP New York, NY
SN 9781260462517
LK accesssurgery.mhmedical.com/content.aspx?aid=1178710198
RD 2021/03/03
AB Auxiliary  liver  grafts  are  temporary  allografts  transplanted  to  provide  hepatocyte  function  during  acute  liver  failure  (ALF)  in  an  otherwise  previously  healthy  patient  expected  to  recover  endogenous  liver  function  through  normal  liver  regeneration.  This  approach  can  potentially  spare  the  need  for  future  immunosuppression,  as  the  auxiliary  graft  can  be  allowed  to  reject  once  native  liver  function  recovers.In  1990  heterotopic  auxiliary  liver  transplantations  (HALTs)  were  described  to  provide  a  hepatic  mass  for  patients  with  ALF,1  yet  were  marred  by  high  rates  of  mortality  and  complications,  stemming  in  part  from  venous  outflow  obstruction  and  lack  of  accommodating  heterotopic  locations.However,  with  further  refinement,  auxiliary  partial  orthotopic  liver  transplantation  (APOLT)  improved  the  previously  unforgiving  rates  of  primary  nonfunction  and  allograft  failure,  with  small  European  experiences  demonstrating  parity  between  orthotopic  liver  transplantation  (OLT)  and  APOLT.2,3APOLT  encompasses  the  transplantation  of  a  left  graft  or  left  lateral  section  to  a  patient  in  ALF.  A  left  lateral  sectionectomy  is  performed  to  accommodate  the  graft  and  provide  adequate  venous  drainage.  The  transplant  allograft  bridges  the  patient  through  ALF  until  the  native  liver  can  recover.  Over  time,  immunosuppression  can  be  slowly  weaned,  such  that  the  transplanted  allograft  is  rejected  and  involutes.4Yet  despite  improvements  in  technique  and  strategy,  auxiliary  liver  transplantation  has  failed  to  garner  widespread  adoption,  even  within  the  small  subset  of  patients  who  present  with  fulminant,  yet  recoverable  liver  failure,  as  in  patients  with  acetaminophen  or  mushroom  overdoses.APOLT  served  as  the  technical  basis  for  the  RAPID  (resection  and  partial  liver  segment  two-thirds  transplantation  with  delayed  total  hepatectomy)  concept  in  liver  transplantation,  with  similar  technique  in  anastomosis  and  approach  (Fig.  22-1).