ilts2008 Poster printing sponsored by : 461-P Fulminant Liver Failure Walid Faraj Auxiliary liver transplantation for acute liver failure in children Walid G. Faraj, Gabriele Marangoni, Faisal Dar, Nemer Kharroubi, Deborah Mukherji, Anil Dhawan, Marriane Samyn, Nigel Heaton, Hector Vilca-Melendez, Mohamed Rela Introduction Acute liver failure (ALF) is severe impairment of liver function in the absence of pre-existing liver disease; it is often fatal in children, with a high mortality rate in the absence of liver transplantation]. However with the advent of intensive care therapy and innovations in liver transplantation techniques, survival rates have improved significantly. Therefore considering the possibility that some patient’s own liver may recover, auxiliary liver transplantation has been introduced to support these patients until their native liver recovers with a possible withdrawal of immunosuppression. Patients and Methods: From 1990 to the present, 126 livers transplantation were performed in children presenting with ALF. Of 126, 16 (11 male and 5 female) received cadaveric auxiliary liver transplants for acute liver failure. The median age was 12 years (range: 2.3 -16). The main indication for transplantation was Non-A Non-B hepatitis (NANB) in 12, drug induced in 2, one autoimmune and one mushroom poisoning. The median waiting time for transplantation was 4 days (range 1-18). Results Patient and graft survival was 81.3% at 1, 5 and 10 years respectively. Of 16 children, there were 3 deaths on day 8, 9 and 52 post transplantation. In the surviving children there were no biliary or vascular complications. There was one retransplant for chronic rejection 15 months post APOLT.Of the 13, 7 (54%) were successfully withdrawn from their immunosuppression at a median time of 30.5 months (range 17-103) after transplantation. Discussion: The major challenge is to differentiate between patients who will benefit from auxiliary liver transplantation (ALT), orthotopic liver transplantation (OLT) and those who will survive without transplantation. There is very little experience with ALT in children; this may be due to lack of experience in smaller size liver transplantation. The two major limiting factors are intracranial pressure and size match organs. There is currently no consensus regarding which technique should be used for auxiliary transplantation. Recently, the use of APOLT has been favoured over heterotopic ALT because it is anatomically more convenient to implant a partial graft after excising the size matched segment of the native liver. APOLT reduces the problems of space occupying, venous outflow and portal vein competition. The type of graft used and hepatectomy depend on volume of graft necessary to achieve greater than 1% body weight graft volume. There are still some controversies in the use of auxiliary liver transplant. One of which is the portal vein flow competition between the native liver and the graft. We suggest that portal vein ligation is generally unnecessary in ALT for ALF. References 1. Bismuth H, Samuel D, Castaing D, Adam R, Saliba F, Johann M, et al.Orthotopic liver transplantation in fulminant and subfulminant hepatitis. The Paul Brousse experience. Ann Surg 1995; 222:109–119. 2. O’Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989; 97:439– 445. 3. Chenard-Neu MP, Boudjema K, Bernuau J, Degott C, Belghiti J, Cherqui D, et al. Auxiliary liver transplantation: regeneration of the native liver and outcome in 30 patients with fulminant hepatic failure - a multicenter European study. Hepatology 1996; 23: 1119-27.