Partial hepatectomy after liver transplantation: systematic review and pooled analysis of indications, techniques and outcomes

BACKGROUND: Partial hepatectomy after orthotopic liver transplantation (OLT) is a graft-saving option that may be used to avoid or delay re-transplantation. We assessed the indications, techniques and outcomes of partial hepatectomy in OLT recipients. METHODS: A PRISMA-compliant systematic review was performed on PubMed, Scopus, and Web of Science. Original studies reporting partial hepatectomy in OLT recipients were eligible for inclusion. Pooled analysis was used to report clinical outcomes. RESULTS: Sixteen studies (n = 135 patients) were included in the systematic review. Main indications for partial hepatectomy were recurrent HCC (41.5%), biliary complications of OLT (25.9%) and other de novo tumors (16.3%). Pooled analysis showed a mean interval between OLT and partial hepatectomy of 47.0 months, heterogeneous based on the indication for resection. Major hepatectomy was used in 40.2% of cases, minimally invasive liver surgery (MILS) in 8.8%. Postoperative morbidity, major morbidity and mortality rates were 48.0%, 17.0% and 7.4% respectively. Additional long-term morbidity and re-transplantation rates were 20.3% and 11.1%. CONCLUSIONS: In carefully selected OLT recipients, partial hepatectomy is feasible and safe. The use MILS should be further explored. Prospective data with detailed stratification of patients based on the perioperative risks and expected long-term outcomes are needed.