la transplantation hépatique pour insuffisance hépatique post hépatectomie

Please participate in the present survey and spread it to Hepatologists and Intensivists about the place of urgent liver transplantation for deemed irreversible and rapidly fatal liver failure following liver resection. The survey will take less than 10 minutes

Description :

The following summarizes the rationale for the present survey:

Liver resection is the mainstay of most malignant and selected benign liver tumors. Post-hepatectomy liver failure (PHLF) of any stage occurs in the region of 10% of cases (Rahbari Surgery 2011), is severe in 0.5% to 7.4% (Prodeau J Hepatol. 2019) of cases, and represents, by far the leading cause (up to 75%) of early postoperative mortality (Helling HPB 2006, Hammond Br J Surg 2011, van Mierlo J Hepatol 2016, Sultana HPB 2018) despite aggressive monitoring in a specialized intensive care unit (Lafaro J Gastrointest Surg. 2015, Søreide Eur J Surg Oncol. 2021).

Considering that nearly half of mortality due to PHLF occurs within 30 postoperative days (Gilg Scand J Gastroenterol. 2018), urgent LT is in practice the only lifesaving option for the rescue of severe PHLF deemed irreversible and fatal, the definition of which remains lacking. In the short term, the option of rescue LT raises the issue of the futility of LT i.e., early mortality due to the severe condition of the potential candidates. In the long-term, this option raises the issue of its oncological legitimacy when hepatectomy was performed for malignancy. Addressing the above issues is made more complex by i) the current brain-dead organ shortage and ii) the equipoise to fulfill and the logistical burdens when living donor LT (LDLT) is considered in an emergency setting. The current knowledge of LT for PHLF remains limited to scarce case reports and small case series. The objective of the present international survey is to evaluate the approach to LT in the presence of PHLF among expert surgeons, hepatologists, and intensivists by submitting them to a clinical vignette study of 6 cases of PHLF.

Of course, i) your answer will be anonymized ii) you will be informed of relevant progress.

Thank you in advance for your participation.

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Lien vers le questionnaire :

Etude cloturée

Renseignements complémentaires :

Prof Daniel Azoulay : daniel.azoulay@aphp.fr

Dr Marc-Antoine Allard : marcantoine.allard@aphp.fr

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