Auxiliary partial orthotopic liver transplantation for total staged hepatectomy in non-resectable metastatic disease : exploration of a new surgical model. Followed by : Personal contributions to the surgery of liver, portal hypertension, and inferior vena cava

Coubeau, Laurent
(2025)

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Authors
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Leclercq, Isabelle
Abstract
Liver transplantation has profoundly transformed the prognosis of hepatic disease, opening new therapeutic horizons for patients once considered beyond cure. Among these advances, the RAPID procedure (Resection and Partial Liver Segment 2/3 Transplantation with Delayed Completion Hepatectomy) stands as an innovative approach at the crossroads of liver regeneration, high-precision surgery, and biological patient selection. This doctoral work explores the pathophysiological and haemodynamic foundations of the RAPID concept, its pro-angiogenic mechanisms, and its clinical translation within the ALDAPT protocol developed at UCLouvain. Through a cohort of patients transplanted for unresectable colorectal liver metastases, the study assesses graft regeneration, vascular tolerance, survival outcomes, and tumour recurrence patterns. The results demonstrate the feasibility and safety of the RAPID model, showing overall survival comparable or superior to conventional liver transplantation, with a predominance of late pulmonary recurrences and very few intrahepatic relapses. These findings support the notion that liver transplantation, beyond its technical dimension, represents a unique biological platform for studying the dynamics of regeneration and tumour recurrence. Beyond the scientific contribution, this thesis pays tribute to the human and collective dimension of surgery — a rare alliance of rigour, humility, and meaning that continues to give medicine its true purpose.
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Coubeau, L. (2025). Auxiliary partial orthotopic liver transplantation for total staged hepatectomy in non-resectable metastatic disease : exploration of a new surgical model. Followed by : Personal contributions to the surgery of liver, portal hypertension, and inferior vena cava.