• Annals of surgery · Nov 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.
    • Hepatopancreatobiliary Surgery and Liver Transplantation Unit, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
    • Ann. Surg. 2024 Nov 1; 280 (5): 753762753-762.

    BackgroundThe Resection And Partial Liver Transplantation with Delayed total hepatectomy (RAPID) 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 grafts exposed to portal overflow without triggering small-for-size syndrome.MethodsA prospective single-center protocol included 8 living donors and 8 RAPID noncirrhotic 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 computed tomography and 99Tc-mebrofenin scintigraphy on postoperative days 7 and 14. Findings were compared with retrospective data from 13 left living donor liver transplantation (LDLT) recipients.ResultsThe median Graft-body weight ratio was 0.41% (interquartile range: 0.34-0.49), 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 posttransplantation. Indexed portal flow (indexed portal vein flow) was significantly higher in RAPID compared with 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.

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