• Annals of surgery · Aug 2024

    In-depth Clinical, Haemodynamic and Volumetric Assessment of the RAPID-type Auxiliary Liver Transplantation in Non-cirrhotic Setting; are we Simply Dealing with a Transplant Model of ALPPS?

    • Laurent Coubeau, Alix Fontaine, Olga Ciccarelli, Eliano Bonaccorsi, Max Derudder, Géraldine Dahqvist, Lancelot Marique, Raymond Reding, Isabelle A Leclercq, and Alexandra Dili.
    • Hepatobiliary and Liver transplantation Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
    • Ann. Surg. 2024 Aug 7.

    BackgroundThe RAPID (Resection And Partial Liver Transplantation with Delayed total hepatectomy) procedure involves left hepatectomy with orthotopic implantation of a left lobe and right portal vein ligation. This technique induces volumetric graft increase, allowing for a right completion hepatectomy within 15 days. Notably, there is a lack of data on the hemodynamics of Small-for-Size (SFS) grafts exposed to portal overflow without triggering SFS syndrome.MethodsA prospective single-center protocol included eight living donors and eight RAPID non-cirrhotic recipients. Comprehensive clinical and biological data were collected, accompanied by intraoperative arterial and portal flow and pressure measurements. Early kinetic growth rate (eKGR%) and graft function were assessed using CT and 99Tc-mebrofenin scintigraphy on postoperative days 7 and 14. Findings were compared with retrospective data from13 left Living Donor Liver Transplantation (LDLT) recipients.ResultsThe median Graft-body weight ratio was 0.41% (IQR, 0.34 to 0.49), markedly lower than in LDLT. However, there was no significant difference in eKGR between RAPID and LDLT grafts. Sequential analysis revealed variable eKGR per day: 10.6% (7.8-13.2) in the first week and 7.6% (6-9.1) in the second week post-transplantation. Indexed portal flow (iQpv) was significantly higher in RAPID compared to left LDLT (P=0.01). No hemodynamic parameters were found to correlate with regeneration speed. We modulated portal flow in 2 out of 8 cases.ConclusionsThis study presents the first report of hemodynamic and volumetric data for the RAPID technique. Despite initial graft volumes falling below conventional LDLT recommendations, the study highlights acceptable clinical outcomes.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…