Clinical application value of small-for-size left lobe liver auxiliary partial orthotopic liver transplantation for treatment of decompensated cirrhosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TANG Gang ^1,2 , KONG Lingxiang ^1,2 ,  YANG Jiayin ^1,2

1. Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

YANG Jiayin, Email: doctoryjy@scu.edu.cn

Keywords：

auxiliary partial orthotopic liver transplant; decompensated cirrhosis; small-for-size graft; hepatitis B

DOI：

10.7507/1007-9424.202410018

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Objective To investigate the clinical value of small-for-size left lobe liver auxiliary partial orthotopic liver transplantation (APOLT) in the treatment of decompensated cirrhosis. Method The preoperative and postoperative clinical data of 4 patients who received small-for-size left lobe liver APOLT in 2023 were retrospectively described and analyzed. Results One patient suffered metabolic liver disease cirrhosis and the other three suffered hepatitis B cirrhosis, all of whom presented with decompensated cirrhosis. Preoperative evaluation showed that the graft-to-recipient weight ratio was less than 0.6%. All recipients underwent left hemihepatectomy. The grafts were derived from living donors in 3 cases, from donation after citizen death in 1 case. After APOLT treatment, 4 patients and grafts survived, 1 patient experienced transplantation rejection and recovered after modified anti-rejection therapy. Three patients with hepatitis B cirrhosis were treated with nucleoside analogues and hepatitis B immunoglobulin, the hepatitis B virus DNA was negative at the end of follow-up, one of three patients with hepatitis B cirrhosis showed negative results for hepatitis B virus in the graft biopsy at month one after surgery. Conclusions From the summary results of these cases, small-for-size left lobe liver APOLT can be used to treat decompensated cirrhosis. The application and popularization of this treatment regimen is expected to expand the donor pool and benefit more decompensated cirrhosis patients with lower Model for End-stage Liver Disease score.

Citation： TANG Gang, KONG Lingxiang, YANG Jiayin. Clinical application value of small-for-size left lobe liver auxiliary partial orthotopic liver transplantation for treatment of decompensated cirrhosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(3): 313-318. doi: 10.7507/1007-9424.202410018 Copy

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2.	Hsu YC, Huang DQ, Nguyen MH. Global burden of hepatitis B virus: current status, missed opportunities and a call for action. Nat Rev Gastroenterol Hepatol, 2023, 20(8): 524-537.
3.	戴二黑, 郭心如, 王继涛, 等. 肝硬化的病因及防治现状调查. 中华医学杂志, 2023, 103(12): 913-919.
4.	Hui AY, Chan HL, Leung NW, et al. Survival and prognostic indicators in patients with hepatitis B virus-related cirrhosis after onset of hepatic decompensation. J Clin Gastroenterol, 2002, 34(5): 569-572.
5.	D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol, 2006, 44(1): 217-231.
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8.	Kim SH, Kim KH, Cho HD. Donor safety of remnant liver volumes of less than 30% in living donor liver transplantation: A systematic review and meta-analysis. Clin Transplant, 2023, 37(9): e15080. doi: 10.1111/ctr.15080.
9.	Feng Y, Han Z, Wang X, et al. Association of graft-to-recipient weight ratio with the prognosis following liver transplantation: a meta-analysis. J Gastrointest Surg, 2020, 24(8): 1869-1879.
10.	Lee SG. A complete treatment of adult living donor liver transplantation: a review of surgical technique and current challenges to expand indication of patients. Am J Transplant, 2015, 15(1): 17-38.
11.	Rela M, Kaliamoorthy I, Reddy MS. Current status of auxiliary partial orthotopic liver transplantation for acute liver failure. Liver Transpl, 2016, 22(9): 1265-1274.
12.	Shanmugam NP, Valamparampil JJ, Reddy MS, et al. Auxiliary partial orthotopic liver transplantation for monogenic metabolic liver diseases: single-centre experience. JIMD Rep, 2019, 45: 29-36.
13.	Inomata Y, Kiuchi T, Kim I, et al. Auxiliary partial orthotopic living donor liver transplantation as an aid for small-for-size grafts in larger recipients. Transplantation, 1999, 67(10): 1314-1319.
14.	ten Kate FJ, Schalm SW, Willemse PJ, et al. Course of hepatitis B and D virus infection in auxiliary liver grafts in hepatitis B-positive patients. A light-microscopic and immunohistochemical study. J Hepatol, 1992, 14(2-3): 168-175.
15.	Chen J, Yi L, Jia JD, et al. Hepatitis B immunoglobulins and/or lamivudine for preventing hepatitis B recurrence after liver transplantation: a systematic review. J Gastroenterol Hepatol, 2010, 25(5): 872-879.
16.	Scatton O, Azoulay D, Castaing D, et al. Auxiliary partial orthotopic liver transplantation using small grafts. A way to avoid small-for-size syndrome?. Gastroenterol Clin Biol, 2005, 29(1): 76-79.
17.	Cho JY, Suh KS, Kwon CH, et al. Auxiliary partial orthotopic living donor liver transplantation in a patient with alcoholic liver cirrhosis to overcome donor steatosis. Transpl Int, 2006, 19(5): 424-429.
18.	朱志军, 魏林, 张海明, 等. 小体积移植物辅助性肝移植治疗门静脉高压症的临床效果. 中华外科杂志, 2023, 61(3): 220-226.
19.	中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国活体肝移植供者微创手术技术指南(2024年版). 中国普外基础与临床杂志, 2024, 31(3): 285-296.
20.	Ge J, Perito ER, Bucuvalas J, et al. Split liver transplantation is utilized infrequently and concentrated at few transplant centers in the United States. Am J Transplant, 2020, 20(4): 1116-1124.
21.	Hu TH, Chen CL, Lin CC, et al. Section 14. Combination of entecavir plus low-dose on-demand hepatitis B immunoglobulin is effective with very low hepatitis B recurrence after liver transplantation. Transplantation, 2014, 97 Suppl 8: S53-S59.
22.	Mehrabi A, Esmaeilzadeh M, Fonouni H, et al. The role of HBIg as hepatitis B reinfection prophylaxis following liver transplantation. Langenbecks Arch Surg, 2012, 397(5): 697-710.
23.	Wang SF, Chen XP, Chen ZS, et al. Left lobe auxiliary liver transplantation for end-stage hepatitis B liver cirrhosis. Am J Transplant, 2017, 17(6): 1606-1612.
24.	Wei L, Zhang HM, Wan CD, et al. Auxiliary liver graft can be protected from HBV infection in HBsAg positive blood circulation. Front Med (Lausanne), 2021, 8: 726502. doi: 10.3389/fmed.2021.726502.

1. Devarbhavi H, Asrani SK, Arab JP, et al. Global burden of liver disease: 2023 update. J Hepatol, 2023, 79(2): 516-537.
2. Hsu YC, Huang DQ, Nguyen MH. Global burden of hepatitis B virus: current status, missed opportunities and a call for action. Nat Rev Gastroenterol Hepatol, 2023, 20(8): 524-537.
3. 戴二黑, 郭心如, 王继涛, 等. 肝硬化的病因及防治现状调查. 中华医学杂志, 2023, 103(12): 913-919.
4. Hui AY, Chan HL, Leung NW, et al. Survival and prognostic indicators in patients with hepatitis B virus-related cirrhosis after onset of hepatic decompensation. J Clin Gastroenterol, 2002, 34(5): 569-572.
5. D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol, 2006, 44(1): 217-231.
6. 王海波, 史赢, 周稚烨, 等. 2019年中国器官捐献与移植等待现状分析. 中华器官移植杂志, 2021, 42(6): 324-325.
7. 吕涛, 徐岗, 徐西, 等. 华西双供体肝脏移植专家共识. 中国普外基础与临床杂志, 2024, 31(4): 385-388.
8. Kim SH, Kim KH, Cho HD. Donor safety of remnant liver volumes of less than 30% in living donor liver transplantation: A systematic review and meta-analysis. Clin Transplant, 2023, 37(9): e15080. doi: 10.1111/ctr.15080.
9. Feng Y, Han Z, Wang X, et al. Association of graft-to-recipient weight ratio with the prognosis following liver transplantation: a meta-analysis. J Gastrointest Surg, 2020, 24(8): 1869-1879.
10. Lee SG. A complete treatment of adult living donor liver transplantation: a review of surgical technique and current challenges to expand indication of patients. Am J Transplant, 2015, 15(1): 17-38.
11. Rela M, Kaliamoorthy I, Reddy MS. Current status of auxiliary partial orthotopic liver transplantation for acute liver failure. Liver Transpl, 2016, 22(9): 1265-1274.
12. Shanmugam NP, Valamparampil JJ, Reddy MS, et al. Auxiliary partial orthotopic liver transplantation for monogenic metabolic liver diseases: single-centre experience. JIMD Rep, 2019, 45: 29-36.
13. Inomata Y, Kiuchi T, Kim I, et al. Auxiliary partial orthotopic living donor liver transplantation as an aid for small-for-size grafts in larger recipients. Transplantation, 1999, 67(10): 1314-1319.
14. ten Kate FJ, Schalm SW, Willemse PJ, et al. Course of hepatitis B and D virus infection in auxiliary liver grafts in hepatitis B-positive patients. A light-microscopic and immunohistochemical study. J Hepatol, 1992, 14(2-3): 168-175.
15. Chen J, Yi L, Jia JD, et al. Hepatitis B immunoglobulins and/or lamivudine for preventing hepatitis B recurrence after liver transplantation: a systematic review. J Gastroenterol Hepatol, 2010, 25(5): 872-879.
16. Scatton O, Azoulay D, Castaing D, et al. Auxiliary partial orthotopic liver transplantation using small grafts. A way to avoid small-for-size syndrome?. Gastroenterol Clin Biol, 2005, 29(1): 76-79.
17. Cho JY, Suh KS, Kwon CH, et al. Auxiliary partial orthotopic living donor liver transplantation in a patient with alcoholic liver cirrhosis to overcome donor steatosis. Transpl Int, 2006, 19(5): 424-429.
18. 朱志军, 魏林, 张海明, 等. 小体积移植物辅助性肝移植治疗门静脉高压症的临床效果. 中华外科杂志, 2023, 61(3): 220-226.
19. 中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国活体肝移植供者微创手术技术指南(2024年版). 中国普外基础与临床杂志, 2024, 31(3): 285-296.
20. Ge J, Perito ER, Bucuvalas J, et al. Split liver transplantation is utilized infrequently and concentrated at few transplant centers in the United States. Am J Transplant, 2020, 20(4): 1116-1124.
21. Hu TH, Chen CL, Lin CC, et al. Section 14. Combination of entecavir plus low-dose on-demand hepatitis B immunoglobulin is effective with very low hepatitis B recurrence after liver transplantation. Transplantation, 2014, 97 Suppl 8: S53-S59.
22. Mehrabi A, Esmaeilzadeh M, Fonouni H, et al. The role of HBIg as hepatitis B reinfection prophylaxis following liver transplantation. Langenbecks Arch Surg, 2012, 397(5): 697-710.
23. Wang SF, Chen XP, Chen ZS, et al. Left lobe auxiliary liver transplantation for end-stage hepatitis B liver cirrhosis. Am J Transplant, 2017, 17(6): 1606-1612.
24. Wei L, Zhang HM, Wan CD, et al. Auxiliary liver graft can be protected from HBV infection in HBsAg positive blood circulation. Front Med (Lausanne), 2021, 8: 726502. doi: 10.3389/fmed.2021.726502.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical application value of small-for-size left lobe liver auxiliary partial orthotopic liver transplantation for treatment of decompensated cirrhosis

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