Institute of Liver Studies, King's Health Partners at King's College Hospital, London, UK.
Curr Opin Organ Transplant. 2011 Oct;16(5):489-93. doi: 10.1097/MOT.0b013e32834a94cf.
Auxiliary liver transplantation (ALT) has developed as a technique for treating patients with acute liver failure. The surgical techniques of ALT have been refined and current patient survival appears to be similar to that observed with conventional liver replacement for acute liver failure.
Our understanding of liver regeneration has improved with experience and it is possible to identify patient and disease groups that are more likely to regenerate and wean off immunosuppression after ALT. Withdrawal of immunosuppression is possible in at least two thirds of survivors up to 4 years post transplant. Young patients have most to gain in the long term from immunosuppression withdrawal. Documentation of liver regeneration should be performed by liver histology, nuclear medicine scanning and CT volumetry. Weaning should be gradual to allow for graft atrophy to avoid complications. ALT has also been utilised for the management of inborn errors of metabolism based in the liver and for other rare problems and these will be briefly addressed in the review.
Auxiliary liver transplantation should be considered for the treatment of children with acute liver failure satisfying current criteria for liver transplantation.
辅助性肝移植（ALT）已发展成为治疗急性肝功能衰竭患者的一种技术。ALT 的手术技术已经得到了改进，目前患者的存活率似乎与急性肝功能衰竭常规肝移植观察到的存活率相似。
随着经验的积累，我们对肝脏再生的理解有所提高，并且可以识别出更有可能在 ALT 后再生并逐渐减少免疫抑制的患者和疾病群体。在移植后至少 4 年，至少三分之二的幸存者可以停用免疫抑制剂。从长期来看，年轻患者从免疫抑制剂停药中获益最大。肝组织学、核医学扫描和 CT 体层摄影术应进行肝再生的评估。逐渐减少免疫抑制剂量以允许移植物萎缩，避免并发症。ALT 也已用于治疗基于肝脏的先天性代谢错误和其他罕见问题，本文将简要介绍这些问题。
对于符合当前肝移植标准的急性肝功能衰竭儿童，应考虑辅助性肝移植治疗。
