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.

Three Consequent Pediatric Liver Transplant Deaths in the COVID-19 Era.

The effect of COVID-19 on the transplant recipients is not well-established. Many reports underestimate the effect of COVID-19 on the immunosuppressed population. Herein, we report on 3 pediatric liver transplant recipients who were transplanted at our center between February 11 and March 10, 2020-during the COVID-19 pandemic era. The 3 patients aged between 5 and 10 months, had a rapid and aggressive respiratory deterioration that necessitated mechanical ventilation and extracorporeal life support; and eventually died. The clinical and pathological pictures likely represent COVID-19 pneumonia. Chest x-rays showed progressive infiltrates. Lung autopsies showed diffuse alveolar damage in two cases. We concluded that COVID-19 is very likely to have catastrophic effects on transplant recipients.

Living donor liver transplantation: a life-saving option in emergency situations for diffuse hepatic neuroendocrine tumor metastasis.

Liver metastasis is the main cause of death in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs), but only 10%-20% of metastasis in these cases is resectable at the time of diagnosis. In some cases, medical and interventional radiological treatments may not be effective. Liver transplantation, although controversial, may be an option. Worldwide organ-sharing systems do not provide exception points, but give recommendations for liver transplantation in cases of hepatic metastasis from GEP-NETs due to the issue of fair access to donor organs. Living donor liver transplantation is an option in select cases. Presented here are 2 cases in which living donor liver transplantation was performed in emergency situations as a life-saving procedure, with acceptable survival and without donor complications.

Acquired factor XI deficiency: a rare complication after liver transplantation.

BACKGROUND: A majority of coagulation factors are synthesized in the liver. Factor XI (FXI) deficiency (Rosenthal syndrome) is one of the rare inherited coagulation disorders with an extremely low risk of transmission by liver transplantation (LT). CASE REPORT: We report here the case of a 50-year-old man who unknowingly acquired FXI deficiency by LT. During 1 year of post-transplant follow-up, his activated partial thromboplastin time (aPTT) remained prolonged, but he did not develop bleeding complications. The patient required retransplantation due to chronic rejection and is currently doing well 4 years after his first liver transplantation. CONCLUSIONS: The presence of a prolonged aPTT in a deceased donor should raise suspicion for the presence of rare coagulation factor deficiencies. During urgent, lifesaving procedures such as LT, it may be impossible to avoid transmission. Awareness of this possibility will allow early detection and management.