Liver transplantation in the treatment of severe iatrogenic liver injuries

Abstract

The place of liver transplantation in the treatment of severe iatrogenic liver injuries has not yet been widely discussed in the literature. Bile duct injuries during cholecystectomy represent the leading cause of liver transplantation in this setting, while other indications after abdominal surgery are less common. Urgent liver transplantation for the treatment of severe iatrogenic liver injury may-represent a surgical challenge requiring technically difficult and time consuming procedures. A debate is ongoing on the need for centralization of complex surgery in tertiary referral centers. The early referral of patients with severe iatrogenic liver injuries to a tertiary center with experienced hepato-pancreato-biliary and transplant surgery has emerged as the best treatment of care. Despite widespread interest in the use of liver transplantation as a treatment option for severe iatrogenic injuries, reported experiences indicate few liver transplants are performed. This review analyzes the literature on liver transplantation after hepatic injury and discusses our own experience along with surgical advances and future prospects in this uncommon transplant setting.

Keywords: Acute liver failure; Biliary injury; Iatrogenic liver injury; Liver transplantation; Surgical complication; Tertiary referral center; Urgent liver transplantation; Vascular injury.

Figure 1

Computed tomography scan show a massive intrahepatic hematoma involving the right hepatic lobe and segment IV.

Figure 2

Computed tomography scan show the ischemic liver necrosis after the right hepatic artery embolization.

Figure 3

Intraoperative findings: A huge right lobe hematoma extended to segment IV with signs of extrahepatic rupture.