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Case Reports
. 2019 Jun 26:20:908-913.
doi: 10.12659/AJCR.914456.

Adult Living Donor Liver Re-Transplant Following Late Pediatric Liver Transplant Failure: A Case Report

Hamad Al Bahili  1 , Abdullah Al Garni  1 , Ibrahim Al Hasan  1 , Yazeed M Alsebayel  2 , Maha Al Eid  3 , Ahmed Al Zaharani  2 , Awad Salem Qahtani  1 , Hisham H Negmi  1 , Nasser Al Masri  1
Affiliations
Case Reports

Adult Living Donor Liver Re-Transplant Following Late Pediatric Liver Transplant Failure: A Case Report

Hamad Al Bahili et al. Am J Case Rep. .

Abstract

BACKGROUND Re-transplant of a late failing living donor liver graft using another graft from another living donor is a rare occurrence and is associated with high mortality due to the complexity of the procedure. There are only a few such case series reported in the literature, mainly from South Asia and Japan, where living donor liver transplant is commonly performed, and there are no such reports from Western countries. CASE REPORT This is a case of living donor liver re-transplant for a 28-year-old recipient whose graft failed 14 years after his primary living donor transplant for primary sclerosing cholangitis. The second transplant was a right-lobe graft obtained from a living donor. The presence of portal vein thrombosis in the setting of high Model for End-Stage Liver Disease (MELD) score added to the complexity of the case. The procedure was concluded successfully with an uneventful post-operative course. The patient was discharged 3 weeks after the procedure. One-year follow-up showed a normally functioning graft. CONCLUSIONS Successfully re-transplanting a patient with a failing living donor liver graft from a living donor is possible if sufficient surgical expertise is available and the risk and benefit are carefully considered. This is especially important in countries where a cadaveric graft is difficult to obtain due to organ scarcity.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1.
Figure 1.
Sections showing liver tissue with portal fibrosis, inflammation, and ductular reaction. There are canalicular bile plugs and periportal hydropic swelling of hepatocytes with cytoplasmic clumping and Mallory bodies. No significant lobular inflammation is seen.
Figure 2.
Figure 2.
Portal fibrosis and bile ductular reaction with lymphoplasmacytic portal inflammation. There is an extensive hepatocanalicular cholestasis with mild lobular inflammation.
Figure 3.
Figure 3.
Doppler ultrasound showing intra-hepatic portal vein thrombosis.
Figure 4.
Figure 4.
Computerized tomography (CT) scan of the liver in the venous phase showing intra-hepatic portal vein thrombosis in the graft with enlarged spleen and splenic vein thrombosis with multiple collaterals.
Figure 5.
Figure 5.
CT scan of the graft showing extra-hepatic portal vein patency with intra-hepatic left portal vein thrombosis. The spleen is enlarged with splenic vein thrombosis.
Figure 6.
Figure 6.
Doppler ultrasound of the second graft showing normal flow and velocities of portal vein and hepatic artery.
Figure 7.
Figure 7.
The patient’s progress.
See this image and copyright information in PMC

References

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