Auxilliary Liver Transplantation According to the RAPID Procedure in Non-cirrhotic Patients - Technical Aspects and Early Outcomes

Objective: To present technical details and short-term experiences of Liver transplantation as a two-stage procedure using small for size grafts in a multicenter cohort study. Summary background data: Two-stage liver transplantation using small for size grafts should be a feasible procedure with lower morbidity and mortality rates. Retrospective cohort study between 2015 and 2022 with multicenter experience. Twenty-three RAPID procedures for non-cirrhotic indications were performed in six European centers (twenty with grafts from living donors and three after deceased donation). Procedure´s feasibility, graft volumetric changes, morbidity and mortality of donor and recipient were explored. Results: There was a low donor morbidity (4.3 %) in our cohort. Hypertrophy of the graft was rapid (mean graft volume increases 107% between both stages) and offered the opportunity for remnant-hepatectomy after a median of 14 days. In all cases, porto-mesenteric flow was routed to the graft by right remnant portal vein ligation. Portal vein inflow modulation to alleviate transient harmful portal hypertension was not needed in any case. Early postoperative mortality (4.3 %) of the recipients were low. Ten patients suffered from complications ≥IIIb according to the Clavien-Dindo classification. Conclusion: Two-stage liver transplantation is a feasible option for non-cirrhotic patients allowing the safe use of small for size grafts and could possibly be extended with caution to liver diseases with portal hypertension and cirrhosis. The RAPID technique might be a viable option for expanding the donor pool given the current organ shortage especially for low-MELD patients.