A systematic review of auxiliary liver transplantation of small for size grafts in patients with chronic liver disease

International consensus recommendations for the RAPID procedure in liver transplantation: The RAPID Consensus ISLS 2023 Zurich Collaborative

INTRODUCTION

Since its beginning in 1963, liver transplantation has significantly advanced, now including transplant oncology. As indications broaden, donor supply reduces. The two-stage RAPID procedure (initially abbreviated as "Resection And Partial Liver Segment 2/3 Transplantation With Delayed Total Hepatectomy") has emerged to address the use of small-for-size grafts. However, a comprehensive evaluation of RAPID is essential given its novelty, scarcity, and diverse outcomes reported.

METHODS

The RAPID Consensus International Society of Liver Surgeons 2023 Zurich initiative established evidence around the RAPID procedure using the Danish Model of Consensus. Engaging an international community of specialists, the initiative ensured multidisciplinary involvement and used the GRADE framework to evaluate the quality of evidence and grade the recommendations.

RESULTS

Comprehensive discussions and debates led to internationally recognized recommendations addressing perioperative measures for RAPID. Key recommendations highlighted the significance of standardized nomenclature, specific indications, graft criteria, surgical techniques, optimal interstage timings, and measures to manage potential complications.

CONCLUSION

The consensus provides recommendations for the RAPID procedure, emphasizing transparency and outcome reporting. Establishing dedicated registries can improve care standards, which may ensure the benefits of RAPID by maximizing patient safety and improving outcomes.

Recipient-Donor Sex Constellation in Liver Transplantation for Hepatocellular Carcinoma-An ELTR Study

BACKGROUND & AIMS

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Liver transplantation (LT) is a curative treatment option. We investigated survival outcomes based on recipient-donor sex constellation (RDSC) following LT.

METHODS

We performed a European Liver Transplant Registry analysis, including patients from 1988 to December 2022. The cohort was split into four RDSC groups: female donor female recipient (FDFR), female donor male recipient (FDMR), male donor female recipient (MDFR) and male donor male recipient (MDMR). Survival analysis, including death with recurrence, was performed.

RESULTS

In 7601 LT for HCC with an overall median follow-up of 22.6 months (5.8, 60.7), death was registered in 25.1% and, as primary cause of death, HCC tumour recurrence in 26.0%. There was no statistically significant difference on crude survival estimates among the different RDSC groups (log-rank p = 0.66) with 10-year overall survival (OS) of 54.5% in FDFR, 54.6% in FDMR, 59.1% in MDFR and 56.9% in MDMR. On multivariable analysis, RDSC showed a significant effect on OS (FDFR as reference): MDFR (aHR 0.72, p = 0.023). No significant difference was found for FDMR (aHR 0.98, p = 0.821) and MDMR (aHR 0.90, p= 0.288). Regarding overall registered causes of death, differences between RDSC groups were found in rejection (p = 0.017) and cardiovascular (p = 0.046) associated deaths.

CONCLUSIONS

In female recipients undergoing LT for HCC, male donor grafts were associated with a 28% reduction of mortality compared to female donor grafts.

A modified kidney-sparing portal vein arterialization model of heterotopic auxiliary liver transplantation increases liver IL-6, TNF-α, and HGF levels and enhances liver regeneration: an animal model

BACKGROUND AND AIM

The success of partial donor liver transplantation is affected by the implantation site of the donor liver and the vascular reconstruction approach. We investigated the effects of different donor liver implantation sites and vascular reconstruction approaches on liver regeneration using a rat kidney-sparing heterotopic auxiliary liver transplantation model, with portal vein arterialization (PVA).

METHODS

Sixty male Sprague-Dawley rats underwent end-to-end anastomosis of the donor liver portal vein and the right renal artery stent (control group), or end-to-side anastomosis of the donor liver portal vein and the left common iliac artery (experimental group).

RESULTS

The experimental group had significantly lower plasma levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, and cholinesterase than the control group (all, P < 0.05). The levels of tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), and hepatocyte growth factor (HGF) in the liver were significantly higher in the experimental group than that in the control group (all, P < 0.05). Hematoxylin and eosin (HE) staining of the liver tissue specimens indicated that the experimental group had greater hepatocyte regeneration compared to the control group.

CONCLUSIONS

The modified kidney-sparing PVA model of heterotopic auxiliary liver transplantation is more conducive to liver regeneration with quicker return of liver function.