An Accessory Left Hepatic Vein Draining Into the Atrium Separately: A Rare Unique Finding During Liver Retrieval and a Challenge for Reconstruction of the Cava Prior to Implantation

Abstract

Retrieval of the liver with no damage to major vascular structures is crucial to the successful outcome of a liver transplantation. It is important to identify vascular anomalies during retrieval because any unexpected damage to anomalous arteries or veins can impair perfusion or outflow of the implanted liver and result in primary graft nonfunction. Hence it is a challenge for the implantation surgeon to reconstruct veins or arteries to ensure good perfusion and outflow for the implanted liver. We present a unique case wherein the liver was retrieved from a 43-year-old donor with a background history of dextrocardia; during retrieval an accessory left hepatic vein draining into the right atrium separately was unexpectedly encountered. This was cut separately from the vena cava during retrieval and reconstructed with the cava to be implanted. This case report highlights the technical challenge of reconstructing the vena cava in such circumstances and implanting the liver.