Background: Acute liver failure is a critical condition with a high mortality rate, and liver transplantation is an effective treatment option. Both auxiliary liver transplantation and non-auxiliary liver transplantation can be applied to patients with acute liver failure. However, whether there are differences in their outcomes and how to decide on auxiliary liver transplantation are important issues to address.
Methods: A retrospective analysis was conducted on the clinical data of 45 patients with acute liver failure who underwent liver transplantation at Beijing Friendship Hospital from November 2016 to February 2024.
Results: Among the 45 patients, 17 received auxiliary partial orthotopic liver transplantation (APOLT), and 28 received non-auxiliary partial orthotopic liver transplantation (NAPOLT). Of the 17 APOLT patients, 13 were children and 4 were adults. Among the 28 NAPOLT patients, 20 were children and 8 were adults. Among the APOLT patients, 8 had an unknown cause of admission (liver tissue samples: 87.5% human herpes virus-6B positive), 1 was due to toxic mushroom poisoning, 7 were drug-induced, and 1 had acute HBV; in the NAPOLT group, 9 cases had an unknown cause (liver tissue samples: 66.7% HHV-6B positive), 8 were drug-induced, 3 had acute HBV, 5 were Wilson’s disease, 2 were congenital diseases, 1 were cytomegalovirus hepatitis. Among the 17 APOLT patients, 7 cases had preoperative hepatic encephalopathy of stage 3-4, while 12 cases in the NAPOLT group had preoperative hepatic encephalopathy of stage 3-4. In the 17 APOLT recipients, 12 received living donor liver transplantation (70.6%), 1 received a domino liver transplant, and 4 received deceased donor liver transplants. In the 28 NAPOLT patients, 16 received living donor liver transplantation (57.1%). The GRWR for the APOLT and NAPOLT groups were 1.3±0.6% vs. 1.9±1.0% (p =0.034), respectively. The operative durations for the APOLT and NAPOLT groups were 8.4±1.9 hours vs. 6.5±1.5 hours (p=0.001). There were 4 deaths in the APOLT group and 7 in the NAPOLT group. The 1-year, 3-year, and 5-year survival rates for the APOLT and NAPOLT groups were 82.4%, 76.0%, 76.0% vs. 74.3%, 74.3%, 74.3%, respectively. The median follow-up time for surviving patients was 35months. Of the 13 surviving APOLT patients, 8 (61.5%) have completely withdrawn immunosuppressants.
Conclusion: Both APOLT and NAPOLT can achieve good outcomes in the treatment of acute liver failure. However, APOLT requires longer operative time and is technically more complex. APOLT provides patients the opportunity to withdraw from immunosuppressive therapy and survive relying on their own regenerated liver. HHV-6 may be an essential factor in the development of ALF.