Ex situ liver resection and autotransplantion for end-staged hepatic alverolar echinococcosis - Past, present and future

AbstractHepatic Alveolar echinococcosis (AE) is a late stage cancer-like parasitic infection caused by the larval stage of the metacestode of Echinococcus multilocularis (E. multilocularis). So far, surgery combined with one-year albendazole has been considered as major radical approach against human AE. However, approximately 2/3 of AE patients may usually be diagnosed at too late with the critical invasion to the main vasculatures, and thus, they cannot benefit from a radical resection; Long-term oral benzimidazoles and their potential major side effects and the numerous complications of palliative resections with long-term biliary drainage have motivated surgeons to seek for more radical approaches. Orthotopic liver allo-transplantation, as a last salvage resource, for the treatment of end-stage AE patients was optional modality. However, immediate and long-term post-transplant complications, and especially disease recurrence associated with the use of immune-suppressive agents, the need for donor, and the high economical cost has not made it widely acceptable. Due to special growth pattern of E.multilocularis in the liver, ex vivo liver resection and autotransplantation seems to be effective for end-staged hepatic AE cases. However, its feasibility on a routine basis and its place, if any, in the overall strategy of AE patient care management, remained to be demonstrated. The present series of fifteen cases showed that end stage hepatic AE might be an acceptable indication for ex vivo liver resection and liver auto-transplantation due to their specific growth patterns and sufficient graft volumes (left lateral lobe). This technique requires no organ donor, post-operative immune suppressant with relative low cost than OLT. The early postoperative mortality was low with acceptable morbidity Preoperative precise assessment is necessary and strict patient selection is utmost important.Commentateur: Yves CHAPUIS