Introduction: Due to the limited number of cadavers, alternative techniques and sources have been developed for liver transplant. Heterotopic auxiliary liver transplantation (HALT) is an alternative surgical procedure that can overcome technical difficulties by avoiding removal of the diseased liver in high-risk cirrhotic patients. We present our three longest-surviving HALT cases in the literature.
Methods: Case 1: A 17-year-old female patient with HBV was on the waiting list. CHILD score was 5 (A), MELD score was 9. The patient had portal hypertension and splenomegaly. Because the patient was young and had a low MELD score, HALT from a deceased donor was performed using a split right lobe graft. Thus, the native liver was nursed to a split graft liver, and thanks to the split, liver transplantation was performed to two recipients with one graft. In the surgical procedure, the right colon was deviated medially. The hepatic vein of graft was anastomosed to the inferior vena cava (IVC), the portal vein (PV) to the superior mesenteric vein (SMV), the hepatic artery (HA) to the common iliac artery, and the biliary duct (BD) to the jejunum.
Case 2: The 18 years old male patient was diagnosed with Alagille syndrome. His CHILD score was 8 (B) and MELD score was 21. In the preoperative biopsy, the native liver was not cirrhotic. Therefore, native hepatectomy was not performed for nursing the graft liver . We performed left lobe HALT from his mother in 1999. Four years later, liver transplantation from a deceased donor was performed because the native liver became cirrhotic and the graft had chronic rejection. We performed the same surgical procedure as Case 1.
Case 3: A 28-year-old female patient was diagnosed with cryptogenic cirrhosis, had a CHILD score of 9 (B) and a MELD score of 15. Her medical history included splenectomy, appendectomy, and cholecystectomy. We performed liver transplantation on the patient in 2007 from deceased donor. Due to technical difficulties in dissectionof native liver, the patient underwent a HALT procedure. In this case, VCI was anastomosed to VCI, PV to SMV, HA to infrarenal aorta, and BD to jejunum.
Results: All patients who underwent HALT are still alive and completely healthy. Serum total/direct bilirubin levels within the last week were: 1/0.3, 0.6/0.2 and 1.1/05 mg/dl, respectively. Serum AST/ALT levels were: 47/52, 28/25 and 56/33, respectively.
Conclusion: HALT is a life-saving procedure for cirrhotic recipients who are at high risk for hepatectomy and for recipients with grafts that do not have sufficient volume. It is also the precursor to many other alternative surgical procedures that have been developed subsequently.