Reuse of liver allograft from a brain-dead recipient: A case report

Abstract

We report our first case of deceased-donor liver transplantation (LT) using a reuse liver graft after the first LT. The recipient was a 38-year-old female with fulminant hepatic failure from toxic hepatitis. She had a history of herb intake and her liver function deteriorated progressively. She was enrolled as the Korean Network for Organ Sharing (KONOS) status 1 and the model for end-stage liver disease score was 34. The donor was a 42-year-old male patient who fell into brain death after LT for alcoholic liver cirrhosis. Donation of multiple organs including the transplanted liver graft was performed 10 days after the first LT operation. Since the liver graft appeared to be normal and frozen-section liver biopsy showed only mild fatty changes, we decided to reuse the liver graft. A modified piggy-back technique of the suprahepatic inferior vena cava reconstruction was used. Other surgical procedures were comparable to the standard deceased-donor LT procedures. The explant liver pathology revealed submassive hepatic necrosis, which was compatible with toxic hepatitis. The peak of serum liver enzyme levels were aspartate transaminase 1,063 IU/L and alanine transaminase 512 IU/L at posttransplant day 3. Since the pretransplant general condition of the recipient was very poor, hospital stay was prolonged and she was discharged 51 days after LT operation. She is currently doing well for 3 years to date. Experience in our case and the literature review suggest that a reuse liver graft can be regarded as one of the marginal grafts which can be transplantable to the LT candidates requiring urgent LT.

Keywords: Brain death; Graft relay; Graft reuse; Recipient death; Transmission.

Fig. 1

Pretransplant imaging study findings. The liver was shrunken with development of ascites (A) with preservation of hepatic blood flow (B).

Fig. 2

Gross photograph of the recovered liver graft.

Fig. 3

Gross photograph of the bench work. (A) The suprahepatic inferior vena cava was trimmed at the previous anastomosis line. (B) The infrahepatic inferior vena cava stump was already closed at the time of first transplantation. (C) The main portal vein was transected at the previous anastomosis line. (D) The hepatic artery included a long arterial segment and aortic patch of the first recipient.

Fig. 4

Gross photograph of the inferior vena cava (IVC) reconstruction. (A) The IVC was totally clamped under active venovenous bypass. (B) A 4 cm-long longitudinal incisions were made at the caudal side of the recipient IVC opening. (C) A 4 cm-long longitudinal incisions were made at the caudal side of the graft IVC opening. (D) Two enlarged IVC openings were well matched, making a wide anastomosis opening.

Fig. 5

Gross photograph of the hilar structure reconstruction. (A) The portal vein was reconstructed as end-to-end anastomosis. (B) The redundant portion of the hepatic artery was resected and the graft’s own hepatic artery was anastomosed to the recipient hepatic artery stump. Biliary reconstruction was performed in duct-to-duct anastomosis of the common bile duct with T-tube insertion.

Fig. 6

Gross photograph of the explant liver graft showing parenchymal necrosis.

Fig. 7

Direct celiac arteriogram taken at posttransplant day 1. (A) The hepatic arterial flow was well preserved. (B) The splenic artery was embolized to improve the hepatic arterial flow.

Fig. 8

Posttransplant imaging study findings. There was no abnormality in the computed tomography scans taken at posttransplant 2 weeks (A), 1 year (B), 2 years (C) and 3 years (C).