In-depth Clinical, Haemodynamic and Volumetric Assessment of the RAPID-type Auxiliary Liver Transplantation; Are We Simply Dealing with a Transplant Model of ALPPS?

Abstract

Purpose: RAPID (Resection And Partial Liver Transplantation with Delayed total hepatectomy) consists of a left hepatectomy associated with orthotopic implantation of a left lobe. The rapid volumetric increase of the graft allows a right completion hepatectomy within 15 days. The technical difficulties encountered in this complex procedure are significant and there are still few cases described in the literature. Methods: Six donors and 6 recipients undergoing RAPID transplantation were included in a prospective single-centre protocol. We analyse the early kinetics growth rate (eKGR) by comparing it to that observed in patients receiving a partial graft alone. We performed intraoperative flow and pressure measurements in all patients. Data on conventional Living Donor Liver Transaplantation (LDLT) recipient were extracted retrospectively. We performed sequential hepatobiliary scintigraphy. Results: The indication for transplantation was colorectal and neuroendocrine metastases. Mean Graft-Recipient Weight Ratio was 0,41. No patient presented with Small-for-Size syndrome. 90 days mortality was 16.6%. The mean follow-up for the 5 living recipients was 648 days without associated morbidity. The clinical course of the donors was unremarkable. There was no difference in eKGR between RAPID and LDLT grafts. The indexed portal flow was significantly higher in RAPID than in LDLT. The technique exposes small volume grafts (GRWR <0.5) to full porto-mesenteric flow but this hyperflow only requires surgical modulation in 1 in 6 cases.Sequential analysis eKGR shows no linearity. It was greater in the first week than in the second week after transplantation: mean volume increase of 70.17±27.13% versus 24±12.77%. Conclusions: We highlight the excellent clinical results of the RAPID surgical technique despite initial graft volumes well below those recommended for conventional LDLT. The initial hypothesis of accelerated surgical liver regeneration has not been established: the growth rate of the grafts in the RAPID model corresponds to that found in LDLT