Deceased donor liver transplantation in an adult recipient with situs inversus totalis: A case report of 10-year clinical sequences following primary and repeat transplantation

Abstract

The feasibility of liver transplantation (LT) in adult patients with situs inversus (SI) was demonstrated with advances in surgical techniques. However, SI is very rare, and the experience of LT in adult patients with SI is very limited. We present a case of an adult patient with SI who underwent deceased-donor LT and late retransplantation because of chronic rejection. A 42-year-old man with SI totalis who suffered from acute-on-chronic hepatic failure because of hepatitis B virus-associated liver cirrhosis and alcoholic liver disease was referred to our center and underwent successful orthotopic deceased-donor whole-liver transplantation. We used a modified piggy-back technique with cavo-cavostomy and inserted a tissue expander for mechanical support of the unstably located liver graft. The patient recovered uneventfully. At 3 years after the first LT, this patient underwent retransplantation because of chronic rejection. In the second LT, we used similar surgical techniques, but performed splenectomy to make space to accommodate the second liver graft. The patient was discharged after long hospitalization. At 5 years after the second LT, he underwent living-donor kidney transplantation because of chronic renal failure developed after the second LT. Currently, he has done well for 10 years after the first LT. In conclusion, SI is a rare anomalous condition hindering LT. Careful perioperative planning with thorough assessment of the donor and recipient livers and use of patient-tailored surgical techniques can lead to successful LT.

Situs Inversus Totalis: A Clinical Review

“…The modified piggy-back technique is advocated by others, as well. 121,122 Solutions to overcome anatomic differences include side to-side caval anastomosis, reduced and rotated graft (90 degrees clockwise), for which relatively smaller grafts are to be preferred. 123,124 This technique is most suited for this anatomical variation in the opinion of Sankarankutty.…”

Application of a tissue expander to stabilize graft position in liver transplantation

“…To maintain the orientation of the outflow and inflow vessels of the liver graft in the initially designed position, a large TE was inserted into the left subphrenic space for mechanical support of the liver graft (Fig. 6) [8]. The TE water was gradually removed, and the TE was removed on day 46 after transplantation.…”