Deceased Donor Diver Transplantation Using a Lacerated Graft With Isolated Hyperbilirubinemia

Abstract

The main limitation of liver transplantation is the shortage of organ donors. The scarcity of donor has led to the increased use of marginal grafts. An injured liver, especially lacerated, is generally considered as the marginal graft having high risk and poor outcome because it is susceptible to malfunctioning, bleeding, bile leakage and infection after liver transplantation. However, some authors have reported successful liver transplantation using injured graft under the meticulous care and careful selection of recipient. We report a case of successful liver transplantation using a right liver graft after in situ left hepatectomy with a lacerated graft with hyperbilirubinemia. Recipient was 52 years old male patient with alcoholic liver cirrhosis. He admitted due to esophageal variceal bleeding with a MELD score of 27 and Child Pugh score of 11. The donor was a 23 years old male who had multiple injuries from fall down. Emergency laparotomy was performed for intraabdominal bleeding. But his condition was deteriorated to brain death and liver function test revealed high bilirubin level (6.04mg/dL) and elevated AST/ALT levels (213/224U/L). The graft liver has 5cm vertical linear laceration in the inferior surface of the liver and it was sutured by Nylon 1‐0 in the previous laparotomy. Procurement team decided to perform in situ left hemihepatectomy to discard an injured left liver because bile duct ligation or injury during previous emergency operation was suspected due to hyperbilirubinemia. After liver transplantation using a right graft, liver function was rapidly normalized and he discharged without any major complication.