Auxiliary liver transplantation for fulminant hepatitis B: Results from a series of six patients with special emphasis on regeneration and recurrence of hepatitis B

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Liver Transplantation

August 2002 . Volume 8 . Number 8

Original Articles

Auxiliary liver transplantation for fulminant hepatitis B: Results from a

series of six patients with special emphasis on regeneration and recurrence

of hepatitis B

François Durand* Jacques Belghiti? Handra-Luca?

Francoz* Alain Sauvanet? Marcellin*

Olivier Farges? Jacques Bernuau* Dominique Valla

Abstract

Emergency liver transplantation is the treatment of choice for the most

severe forms of fulminant hepatitis B. Auxiliary liver transplantation is an

attractive alternative, offering the possibility of regeneration and

discontinuation of immunosuppression. However, the use of auxiliary

transplantation for fulminant hepatitis B is controversial because the

remnant part of the native liver could be the source of recurrence of HBV

infection. We report the results of auxiliary liver transplantation in six

patients with fulminant hepatitis B. Postoperatively, all patients received

gancyclovir and anti-hepatitis B surface immune globulins. Graft function

has been satisfactory in all cases and all patients had rapid neurologic

improvement. One patient died with a functional graft because of

disseminated aspergillosis on postoperative day 17. The remaining 5 patients

are currently alive. The 4 patients with more than 1-year follow-up had

complete regeneration of the native liver and are free of immunosuppression.

None of these patients had recurrence of hepatitis B. These results suggest

that the use of an auxiliary graft is a safe alternative in selected

patients with fulminant hepatitis B. Regeneration of the native liver, even

if slow, seems to occur in most cases, allowing discontinuation of

immunosuppression, which is a major advantage over conventional

transplantation. Finally, the remnant part of the native liver does not

compromise immunization against HBV. (Liver Transpl 2002;8:701-707.)

Publishing and Reprint Information

From the *Service d'Hépatologie and INSERM U481, ?Service de Chirurgie

Digestive and ?Service d'Anatomie-Pathologique, Hôpital Beaujon, Clichy,

France.

Address reprint requests to François Durand, MD, Service d'Hépatologie,

Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110 Clichy, France.

Telephone: (33) 14-087-5091; FAX: (33) 14-730-9440; E-mail:

francois.durand@... Copyright © 2002 by the American

Association for the Study of Liver Diseases

1527-6465/02/0808-0006$35.00/0

doi:10.1053/jlts.2002.33745