Heterotopic vs. orthotopic liver transplantation for chronic liver disease: A case‐control comparison of short‐term and long‐term outcomes

• Published in: Liver transplantation Vol. 11; no. 4; pp. 396 - 401
• Main Authors: de Rave, Sjoerd, Hansen, Bettina E., Groenland, Theo H.N., Kazemier, Geert, de Man, Robert A., Metselaar, Herold J., Terpstra, Onno T., Tilanus, Hugo W., IJzermans, Jan H.N.M., Schalm, Solko W.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.04.2005
• Subjects: Adult; Case-Control Studies; Cause of Death; Chronic Disease; Female; Humans; Liver Diseases - mortality; Liver Diseases - surgery; Liver Transplantation - methods; Liver Transplantation - mortality; Male; Middle Aged; Proportional Hazards Models; Survival Analysis; Transplantation, Heterologous; Treatment Outcome
• ISSN: 1527-6465; 1527-6473
• DOI: 10.1002/lt.20376

Between 1986 and 1990 we performed heterotopic liver transplantation (HLT) in 17 patients with chronic liver disease. In spite of theoretical advantages and favorable short‐term results, we abandoned HLT because of doubts about the long‐term outcome and the improved results of standard orthotopic liver transplantation (OLT). There are, however, no studies comparing the long‐term survival after HLT and OLT for chronic liver disease. We performed a case‐control study of HLT vs. OLT, with long‐term patient and graft survival as the main outcome measures. Known confounders and differences in baseline characteristics between HLT and OLT patients were corrected for. At 1 year, 5 of the 17 HLT patients had died, compared with 9 of the 34 OLT patients (relative risk [RR], 1.15; 95% confidence interval [CI], 0.33–4.02; P = 0.83). After correction for confounders, the long‐term risk of graft failure (RR, 18.0; 95% CI, 1.5–223.5; P = 0.02) and of death (RR, 5.2; 95% CI, 0.8–34.8; P = 0.09) was higher after HLT than after OLT. The main causes of graft loss and death at more than 1 year after HLT were de novo malignancies and a variety of biliary complications. In conclusion, our data, from 1 of the largest single‐center series of HLTs available, showed no significant difference between HLT and OLT in 1‐year survival. However, the long‐term outcome of HLT was inferior. HLT cannot be recommended as an alternative to OLT for any of the indications we studied, even though only 1 of the late deaths was definitely related to the heterotopic technique. (Liver Transpl 2005;11:396–401.)