Current status of auxiliary partial orthotopic liver transplantation for acute liver failure

Potential conflict of interest: Nothing to report. TO THE EDITOR: I read with great interest the review article by Rela et al.1 recently published in Liver Transplantation. This is a very interesting review of the subject in which a large part is devoted to historical steps that led to this concept that aims at taking advantage of the possibility of recovery of the native liver and the potential for withdrawal of the liver graft, hence discontinuation of immunosuppression and actual cure. In their historical narration, Rela et al. rightly report that initial attempts at auxiliary transplantation included heterotopic positioning of the graft, below or beside the native liver, avoiding partial hepatectomy of the native liver. In that section of the article, they state that Stampfl et al. reported in 1990 the first case of heterotopic auxiliary liver transplantation (HALT) for acute liver failure (ALF). Indeed, this was the first successful case that served as a bridge to regular orthotopic full graft transplantation at postoperative day 27. However, I reported the first case of HALT for ALF performed in March 1980 that was published in French in 1982 and then in English as part of the first series of partial liver grafts in 1985.2 This was a case of ALF due to drug toxicity of antiepileptic valproic acid in a 17‐year‐old girl. After the initial recovery, the patient developed agranulocytosis that required withdrawal of immunosuppression, and she died of graft rejection at postoperative day 22.2 In this case, space difficulties encountered in full graft HALT led us to use our technique of partial graft consisting of reducing the graft by ex vivo hepatectomy, a technique we first used successfully in pediatric liver transplantation and is since known as “reduced‐sized liver transplantation.”4 This is just a friendly reminder in view of the comprehensive historical part of this article and to revive an old and maybe unfairly overlooked publication.