Split Liver Transplant From Deceased Marginal Donor: A Case Report.

The relative paucity of deceased donor organs and the progressive increase in patients with cirrhosis have led transplant centers to consider organs from marginal donors (elderly donors, prolonged stay in the intensive care unit (ICU), liver steatosis-steatotic grafts, severe hypernatremia, and use of inotropes). Recently, the use of those marginal grafts has increased, but splitting liver is still debatable. Herein, we present a 28-year-old deceased donor who had a history of traumatic brain injury. The patient stayed in ICU for 3 days with high sodium level (188 mEq/L) and was hemodynamically supported with single inotrope. At the time of procurement, core biopsies were taken from the right lobe and left lateral segment of the liver, with results demonstrating 5% necrosis. A decision was made for split liver transplant as left lateral sector and extended right lobe. Liver graft was divided into a left lateral segment to be transplanted to a 4-year-old child with secondary biliary cirrhosis due to previous liver transplant and a right extended liver lobe for an adult patient with hepatocellular carcinoma waiting 10 months on the waiting list. Both liver transplants were performed uneventfully. Patients were discharged on the 11th and 56th days after transplant. The liver function tests remained normal during the follow up period of 2 years. A marginal graft with more than one risk factor should not be discarded liberally. Splitting such grafts could be considered in a highly selective recipients.

Anatomical variations of the hepatic artery: a closer view of rare unclassified variants.

BACKGROUND: Defining the hepatic artery anatomy is of great importance for both surgeons and radiologists. Michel classification was designed to classify hepatic artery variations. Nevertheless, there are variations that do not fit into this classification. In this study, we aim to define the incidence of all variations in a healthy liver donor by reviewing their computed tomography (CT) scan with special emphasis on variations that do not fit in any of the Michel classes. MATERIALS AND METHODS: A retrospective analysis of CT scan of donors and potential liver donors who were evaluated by triphasic CT scan. The CT scans were reviewed independently by a radiologist and two transplant surgeons. Cases that did not fit in any of the Michel classes were classified as class 0. RESULTS: Out of 241 donors, 210 were classified within the Michel classification, of which 60.9% were class I and 9.1% class II. Thirty-one (12.9%) donors classified as class 0. Of which, nine, three, two and three had replaced right hepatic artery from pancreaticoduodenal artery, gastroduodenal artery, aorta and coeliac artery, respectively. Two and six donors had accessory right hepatic artery from pancreaticoduodenal artery and gastroduodenal artery, respectively. Segment 4 artery originated from left and right hepatic artery in 56.8% and 31.9%, respectively. CONCLUSIONS: A great caution should be taken when evaluating the hepatic artery anatomy, clinicians should anticipate and be familiar with the rare unclassified variations of the hepatic artery.