Partial hepatectomy after liver transplantation: systematic review and pooled analysis of indications, techniques and outcomes.
Lorenzo Bernardi, Raffaello Roesel, Alessandra Cristaudi et al.
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In 30 seconds
This PRISMA-compliant systematic review and pooled analysis examined indications, surgical approaches and outcomes of partial hepatectomy after orthotopic liver transplantation (OLT), using 16 studies involving 135 patients. Resection was most often performed for recurrent hepatocellular carcinoma (41.5%), biliary complications (25.9%) or other de novo tumours (16.3%). Pooled postoperative morbidity was 48.0%, major morbidity 17.0% and mortality 7.4%. The authors conclude that partial hepatectomy can be feasible in carefully selected transplant recipients, while noting the need for prospective data and further evaluation of minimally invasive surgery.
Key findings
- Recurrent hepatocellular carcinoma accounted for 41.5% of partial hepatectomies; biliary complications accounted for 25.9%.
- Major hepatectomy was performed in 40.2% of cases, while minimally invasive liver surgery was used in 8.8%.
- Pooled postoperative morbidity was 48.0%, major morbidity 17.0% and mortality 7.4%.
- Long-term morbidity and re-transplantation rates were 20.3% and 11.1%, respectively.
Why it matters
Partial hepatectomy may offer a graft-preserving option for selected OLT recipients with recurrent tumours or biliary complications, potentially avoiding or delaying re-transplantation. The pooled outcomes also show that this is substantial surgery with meaningful postoperative risk. Understanding the indications and reported outcomes can inform assessment of this option, while the evidence base remains limited to published original studies.
What to keep in mind
The review included only 16 studies and 135 patients; the abstract calls for prospective data with detailed risk and outcome stratification. Outcomes may therefore be difficult to generalise across indications and patient risk profiles.