Ex-vivo liver resection and auto-transplantation (ELRA)for advanced alveolar echinococcosis

Complete resection of the lesions associated with 2 years of albendazole treatment represents the most effective treatment of alveolar echinococcosis (AE). Only very few patients can benefit from conventional hepatectomy due to extensive involvement of hepatic AE lesions, others have to be listed for albendazole with or without allotransplantation and/or interventional therapy. Although, allotransplantation was considered as a legitimate option for such advanced cases, however, the shortage of organ donor, the need for post-operative long-term immunosuppressants and possible recurrence with adverse effects of medications motivated surgeons to search for a possible alternative modality. From this perspective, ex vivo liver resection followed by autotransplantation (ELRA) was firstly attempted in end-stage hepatic AE by the authors and currently performed in 94 end-stage hepatic AE patients with promising clinical outcome. Currently available data from the first 69 cases support ELRA as an emerging option for otherwise unresectable end-stage hepatic AE lesions with acceptable 30 days post-operative mortality of 7% with a 100% disease-free survival in survivors. Careful patient selection, precise assessment for size and quality of remnant liver are keys to successful surgery. Further cohorts with higher number of patients with longer follow-up may confirm the results of the present study. (C) 2019 Published by Elsevier Masson SAS on behalf of Academie Nationale De Medecine.