Ex vivo liver resection and auto-transplantation in end-staged Alveolar Echinococcosis - 69 cases experience

Introduction: Radical resection is the best treatment for hepatic alveolar echinococcosis (AE) patients. Liver transplantation is considered for advanced cases, however, shortage of organ donor and post-operative recurrence still is a challenging problem. We performed a prospective study of 69 end-stage patients cured by ex vivo liver resection and autotransplantations. Methods: In a prospective study, we subjected 69 consecutive end-stage hepatic AE patients to treatment with ex vivo liver resection and autotransplantation during January 2010 to February 2017. The clinical results of this series were recorded and the feasibility, safety and outcome of this techniques assessed. Results: Ex vivo extended hepatectomy with autotransplantation was successful with zero intra-operative mortality. The median weight of graft and AE lesion respectively were 850 [370–1600] g and 1650 [375–5000] g. The median duration of operation and anhepatic phase were 15.9 [8–24] hours and 360 [104–879] minutes. Zero blood transfusion was experienced in six patients. Complication higher Clavien-Dindo classification IIIa or higher were experienced in the 10 patients with hepatic dysfunction mostly seen. The peri-operative (1-month) mortality and overall mortality respectively were 7.24% (5/69) and 11.5% (8/69). The mean hospital stay was 34.5 [12–128] days. Patients were closely followed-up with the median follow-up was 10.5 [2–77] months with no recurrence. Conclusion: This is the largest series regarding ex vivo liver resection and autotransplantation end-stage hepatic AE. This technique could be an effective and alternative to liver transplantation in end-staged hepatic AE patients and requires no organ donor and immunosuppressive agents.