Experience of liver transplantation for advanced alveolar echinococcosis

Objective To summarize the clinical experience of liver transplantation (LT) for the treatment of advanced hepatic alveolar echinococcosis ( HAE) . Methods Six patients with advanced HAE underwent LT in the First Affiliated Hospital,Xinjiang Medical University from December 2000 to May 2009 were retrospectively analyzed. Preoperative and postoperative therapy with liposome albendazole ( L-ABZ, 15-20 mg·kg-1·d-1) was used to prevent patients from the recurrence of HAE. Results The overall medium time of the 6 LT procedures and unhepatic phrases were 635. 0 min ( range,490-760 min) and 65. 5 min ( range,44-90 min) ,respectively. The medium transfusion requirement was 20. 5 u ( range, 9-40 u) . Five LT were successfully performed for HAE except for one emergent LT case died of severe hepatic encephalopathy,renal failure and coagulation disorders on day 1 post-LT. The mean follow-up was 9 months ( range,3-19 months) . Three recipients died of incurable infection of biliary tract on day 154 post-LT,septicopyemia on day 98 post-LT,and acute rejection 6 months post-LT,respectively. The recurrence or spread of alveolar echinococcosis larvae in the other 2 cases was not observed although there was a parasitic metastatic lesion in the left lung of the 6th patient 11 months post-LT. The 4th recipient received choledochojejunostomy 8 months after living-LT because of anastomotic obstruction of biliary tract. Conclusion LT is the optimal method of treating advanced HAE. Strict compliance with the LT indications,systemic administration of L-ABZ,and a minimum dose of immunosuppressive agent are necessary to prevent from the recurrence of alveolar echinococcosis and ensure a long-term survival.