Outcomes of Liver Transplantation in Patients with Situs Inversus

Abstract

Introduction: Situs Inversus was considered a contraindication for liver transplant in the past, due to the anatomical difficulties and the associated vascular abnormalities. Nowadays, several studies and series reported successful liver transplant in situs inversus recipients and also from donors. However, it is still rare. Therefore, we conducted a systematic review to assess the transplant techniques and their outcomes in situs inversus individuals. Methods: We searched through four database engines; PubMed, EMBASE, Web of Science, and CINAHL. Articles were included if they reported our main outcomes of surgical technique, morbidity, and mortality of liver transplant in adult patients. Results: 31 reports, including 35 situs inversus individuals, were included in this review. Of which 19 patients were situs inversus recipients, and 14 were donors. The most common reported transplant technique is orthotopic liver transplant with 180° rotation. HBV, HCV, and alcohol-related liver disease were the most common etiologies for end-stage liver disease in situs inversus recipients. The mean MELD score for the situs inversus recipients was 22 (ranged 9-36), the mean hospital stay was 19 days (ranged 7-45), and the operation time ranged from 3.5 to 11.5 hours. The overall complication rate was higher in situs inversus recipients than in patients who receive grafts from situs inversus donors 50% (9/18) and 33.3% (4/12), respectively. Conclusion: Liver transplant in situs inversus recipients is feasible, and liver grafts from situs inversus donors are considered safe. Despite the anatomical intricacy, preoperative planning and the use of proper techniques can lead to successful outcomes.