Total hepatectomy with portocaval shunting (TH-PS) is a last-resort in patients with severe acute liver dysfunction awaiting liver transplantation (LT). The anhepatic state portends dismal outcomes. We describe characteristics and survival rates of patients who underwent TH-PS.
Retrospective analysis of LT recipients from a single academic institution from 1999-2012. Measures included demographics, indication for TH-PS, ABO compatibility, and anhepatic time (AT). The primary outcome was 30 day mortality. AT was dichotomized by times less than or greater than 24 hours. Fishers exact test was used to compare mortality between groups.
Thirteen anhepatic patients were identified, ages 7 months to 61 years. Six (46.1%) were female. 12 underwent salvage LT and 1 died awaiting transplantation. The indications for TH-PS were acute liver failure (n=3, 23.1%), allograft dysfunction after LT due to primary nonfunction (n=7, 53.8%), vascular thrombosis (n=2, 15.4%), and hemorrhage (n=1, 7.7%). ABO incompatible grafts were used in 4 (33.3%). The overall 1, 3 and 5 years survival rates were 54 % (n=7), 46 %( n=6) and 46% (n=6). Patients who underwent LT with AT < 24 hours (n=9, 75.0%) had 100% 30-day and 78% 1-year survival, while patients underwent LT with AT >24 hours (n=3, 25.0%) had no survival at 30 days. 30 day mortality was significantly higher in those with AT>24 hrs, p=0.004.
TH-PS can be life-saving in patients with severe hepatic dysfunction awaiting LT. AT>24 hours is associated with higher mortality. Efforts to minimize AT may require delaying TH-PS until confirmation that a donor is available.
To cite this abstract in AMA style:Lau K, Zarrinpar A, Agopian V, Kaldas F, Farmer D, Busuttil R. How Do Anhepatic Patients Fair? A Single-Center Experience of Thirteen Patients Requiring Total Hepatectomy and Portocaval Shunting for Severe Hepatic Dysfunction [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/how-do-anhepatic-patients-fair-a-single-center-experience-of-thirteen-patients-requiring-total-hepatectomy-and-portocaval-shunting-for-severe-hepatic-dysfunction/. Accessed November 19, 2017.
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