• Riccardo Pravisani, Lorenzo Cocchi, Manuela Cesaretti, Federica Dondero, Ailton Sepulveda, Olivier Farges, Emmanuel Weiss, Valérie Vilgrain, Claire Francoz, Olivier Roux, Jacques Belghiti, Francois Durand, Mickaël Lesurtel, and Safi Dokmak.
• Liver-Kidney Transplant Unit, Department of Medicine, University of Udine, Udine, Italy.
• Ann. Surg. 2023 Nov 1; 278 (5): 790797790-797.

ObjectiveTo investigate whether and how experience accumulation and technical refinements simultaneously implemented in auxiliary orthotopic liver transplantation (AOLT) may impact on outcomes.BackgroundAOLT for acute liver failure (ALF) provides the unique chance of complete immunosuppression withdrawal after adequate native liver remnant regeneration but is a technically demanding procedure. Our department is a reference center for ALF and an early adopter of AOLT.MethodsThis is a single-center retrospective before/after study of a prospectively maintained cohort of 48 patients with ALF who underwent AOLT between 1993 and 2019. In 2012, technical refinements were implemented to improve outcomes: (i) favoring the volume of the graft rather than that of the native liver, (ii) direct anastomosis of graft hepatic artery with recipient right hepatic artery instead of the use of large size vessels, (iii) end-to-side hepaticocholedocostomy instead of bilioenteric anastomosis. Early experience (1993-2011) group (n=26) and recent experience (2012-2019) group (n=22) were compared. Primary endpoint was 90-day severe morbidity rate (Clavien-Dindo≥IIIa) and secondary endpoints were overall patient survival and complete immunosuppression withdrawal rates.ResultsCompared with the earlier experience group, the recent experience group was associated with a lower severe complication rate (27% vs 65%, P <0.001), as well as less biliary (18% vs 54%, P =0.017) and arterial (0% vs 15%, P =0.115) complications. The 1-, 3-, and 5-year patient survival was significantly improved (91%, 91%, 91% vs 76%, 61%, 60%, P =0.045). The rate of complete immunosuppression withdrawal increased to 94% vs 70%, ( P =0.091) with no need of long-term graft explant.ConclusionThese technical refinements favoring the liver graft and reducing morbidity may promote AOLT implementation among LT centers.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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