Auxiliary Partial Orthotopic Liver Transplantation (APOLT)

Partial Liver Transplantation

NYP/Columbia was one of the first institutions to perform Auxiliary Partial Orthotopic Liver Transplantation (APOLT), also called partial or split liver transplantation. This procedure now accounts for a substantial proportion of liver transplants in the U.S., primarily in children.

Patients with fulminant hepatic failure traditionally have had limited options: timely recovery of the native liver with medical management, or liver transplantation. Having revamped a procedure that was largely abandoned in the 1980's, transplant surgeons at NewYork-Presbyterian/Columbia are now able to offer patients an important alternative. In APOLT, the surgeons resect part of the failing native liver and attach a partial donor liver to it. The donor liver supports the patient during recovery, clearing toxins and preventing brain injury. In the majority of patients, the native liver recovers with this support. Immunosuppressant medication can then be withdrawn, and the donor liver withers in most patients.

Although partial liver transplantation is particularly suited to children because the regenerative capacity of their livers is optimal, this technique may also be applied in young adults. In studies it has proven highly successful, with 100% of patients surviving at the time of this publication. Over half of patients have completely withdrawn from immunosuppression and the remainder are in the process of withdrawal. One patient required surgical removal of the donor liver. NewYork-Presbyterian Hospital is one of only a few hospitals worldwide with the expertise to perform partial liver transplantation. A pilot study published in March, 2012 showed that many children who receive a liver from a parent can safely stop using anti-rejection medications.