Ex vivo liver resection and autotransplantation versus allotransplantation for end-stage hepatic alveolar echinococcosis

Objective: The aim of this study was to compare the clinical outcomes of ex vivo liver resection and autotransplantation (ERAT) with allotransplantation in patients with end-stage hepatic alveolar echinococcosis (HAE). Methods: From January 2008 to October 2017, 41 of 254 patients with end-stage HAE fulfilled the inclusion criteria (ERAT group, n = 35; allotransplantation group, n = 6). Each group was assessed for indications and short-and long-term outcomes. Results: The intraoperative mortality was zero in both groups. Two patients died after ERAT due to intra-abdominal bleeding and acute cerebral hemorrhage. The most frequent postoperative complications were biliary complications, which occurred in six patients (14.6%). Parasite recurrence was recorded in two patients, at 16 months and 52 months after allotransplantation. The survival curve showed a longer survival time in the ERAT group than in the allotransplantation group (P = 0.028). In the ERAT group, the 1, 3-, and 5-year overall survival rates were all 100%. In the allotransplantation group, the 1-, 3-, and 5-year overall survival rates were 100%, 83.3%, and 66.7%, respectively. Conclusions: This appears to be the first series comparing ERAT with allotransplantation for end-stage HAE. ERAT may be a superior alternative to allotransplantation in some cases, as it requires neither an organ donor nor immunosuppressive therapy. (c) 2018 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).