Hepatic abscesses after liver transplantation secondary to traumatic intrahepatic bile duct injuries in a cadaveric allograft donor

Abstract

We report the case of an ultimately successful liver transplant recipient whose post-transplant course was complicated by the early development of multiple abscesses in the graft. Post-transplant cholangiography identified multiple shear injuries to the second and third order intrahepatic bile ducts, originating from blunt trauma to the donor liver. Treatment was non-operative following recent reports of the successful management of intrahepatic bile duct injury in the stable trauma patient. This discussion adds to the limited literature available on the transplantation of injured donor livers, despite this being a relatively common practice. Further experience is needed in determining the appropriate criteria for the use of traumatized donor livers. Cholangiography carried out on the back

Hepatic abscess: Diagnosis and management

“…livers originating from donors who are elderly, hemodynamically unstable, in cardiac arrest, post-trauma or who have positive viral serology (presence of anti-HBc antibodies, positive hepatitis C serology). Grafts originating from donors in cardiac arrest or trauma victims seem to have a greater propensity to develop HA [60,61]. In donors with cardiac arrest, the warm ischemia phase between the cardiac arrest and cooling of the graft probably explains the onset of ischemic cholangitis with stenosis and dilatation of the intrahepatic bile ducts.…”

Hepatic abscess: a rare complication after liver transplant

“…Hepatic artery thrombosis (HAT) may be the most common pre‐disposing factor leading to abscess formation, in addition to other major contributors including hepatic artery stenosis, biliary stricture, and Roux‐en‐Y choledochojejunostomy . Donation after cardiac death and traumatized liver graft are rare but important conditions associated with hepatic abscess development …”

Successful outcome following transplantation of an injured liver from a nonheart beating donor

“…The limited availability of organs for transplantation has led to relaxation of selection criteria for livers, and the inclusion of marginal donors. Transplant surgeons have been reluctant to utilize traumatized livers because of concerns regarding the additive effect of parenchymal damage to reperfusion injury related to warm and cold ischaemia, the risk of haemorrhage and subsequently, of septic complications including intrahepatic abscesses related to bile duct shear injuries, or pseudoaneurysm formation [8]. Although, transplantation of traumatized livers has been associated with a higher rate of primary nonfunction (PNF) in a small series of patients, good patient and graft survival rates have been reported with mild to moderate liver injuries [5].…”