Background: Increased worldwide focus on maximal donor utilization and transplantation of patients once considered too ill to survive liver transplantation may increase the otherwise rare frequency of catastrophic graft failure. Although the deleterious effects of a necrotic allograft have been established for decades, the optimal strategy in this patient population in the perioperative period remains ill-defined.

Methods: A retrospective review of all liver transplant recipients with massive post-operative liver necrosis leading to perioperative transplant hepatectomy between 1/1/2014 and 6/30/2017 was performed. All patients were supported with MARS therapy while awaiting retransplantation.

Results: Four patients experienced catastrophic graft failure from massive exsanguination and liver fracture (1), portal vein thrombosis (1), necrosis from inadequate donor perfusion (1), and idiopathic necrosis (1). All patients improved following transplant hepatectomy with portacaval shunting. Patients were supported with intubation, pressors, renal replacement therapy and MARS therapy. All patients underwent retransplantation after a mean anhepatic phase of 48.8 (+/- 5.13) hours. All patients were left with open abdomens following retransplantation, and required multiple procedures following the second transplant. Survival to discharge was 75%.

Conclusions: Although catastrophic liver necrosis presents innumerable challenges to the transplant team, acceptable outcomes can be achieved with timely hepatectomy with portacaval shunt and retransplantation, particularly in patients supported with the MARS device.

CITATION INFORMATION: Cimeno A., Sultan S., Alvarez-Casas J., Hanish S., Bruno D., Hutson W., Stein D., Scalea T., Barth R., LaMattina J. Transplant Hepatectomy with Portacaval Shunt and Molecular Adsorbent Recirculating System (MARS) Therapy for Perioperative Catastrophe Am J Transplant. 2017;17 (suppl 3).

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