A retrospective study on the efficacy of ex vivo liver resection combined with autologous liver transplantation in treating advanced alveolar echinococcosis at high altitude

To evaluate the Feasibility and efficacy of total ex vivo liver resection combined with autologous liver transplantation for the treatment of advanced alveolar echinococcosis in high-altitude regions. A retrospective (consecutive) analysis was conducted on 19 patients who underwent ex vivo liver resection with autologous liver transplantation at Qinghai Provincial People’s Hospital between May 2013 and December 2024. Patient data, including age, gender, ethnicity, intraoperative blood loss, operative time, and follow-up duration, were collected and subjected to descriptive statistics and comparative analysis. All 19 patients with advanced hepatic alveolar echinococcosis (HAE) successfully underwent ex vivo liver resection with autotransplantation (ELRA) with no intraoperative mortality. Postoperative complications occurred in 84.2% (16/19) of cases. Perioperative mortality was 15.8% (3/19), including deaths due to massive intra-abdominal hemorrhage (1 case), intracranial hemorrhage (1 case), and septic shock (1 case). The median operative time was 840 min (range, 500–1277), with a median intraoperative blood loss of 2000 mL (range, 600–12000 mL). Inferior vena cava reconstruction primarily utilized synthetic graft interposition (63.2%, 12/19), while portal vein reconstruction mostly employed suture repair (89.5%, 17/19). Among 16 surviving patients, the median follow-up duration was 595 days, with no recurrence of HAE observed. Three additional deaths occurred during follow-up. ELRA demonstrated technical feasibility in high-altitude regions but requires vigilant monitoring for unique complications such as postoperative intracranial hemorrhage. Despite the elevated surgical risks imposed by the unique high-altitude environment, total ex vivo liver resection combined with autologous liver transplantation demonstrates feasibility and potential clinical value as a treatment option for advanced hepatic alveolar echinococcosis (HAE) in plateau regions. This technique significantly improves patients’ quality of life and long-term prognosis, demonstrating strong feasibility and clinical efficacy. It thus represents a valuable new treatment option for patients with end-stage HAE.