Reconstruction of Calcified Hepatic Artery in the Donor Liver: A Case Report

Abstract

The transplant teams may even push the boundaries outside the norm to ensure optimal outcome from donation. An offer of liver graft from 58 years old female DBD donor was accepted. Donor history entailed type I diabetes mellitus, hypertension and previous hemodialysis, before undergoing cadaveric renal transplant. A male recipient with cryptogenic cirrhosis and HCC with UKELD of 58, was selected as the recipient. The organ was retrieved by a different surgical team, once the images of the liver were received and the retrieval team reported no anomalies or injuries, recipient hepatectomy was stared prior to the graft arrival in order to keep the cold ischemia time as short as possible. On back table dissection of the liver graft it was identified that the donor common hepatic artery was heavily calcified. As the recipient was already anhepatic therefore after careful consideration it was decided to precede with the implantation of the donor liver. Recipient CHA was prepared at the GDA junction and corresponding CHA/GDA patch on the graft. A 5mm diameter extruding calcified plaque was excised from the site of the anastomosis but most of the circumference of graft patch had integrated wall calcification which could not be excised. On table Doppler USS suggested extensive intrahepatic calcification but excellent traces after arterial reconstruction. The Peak systolic volume was >60cm. Graft function was evident by good bile production, normal TEG, INR and lactate clearance. We believe that hepatic artery atherosclerosis on its own is not an absolute contraindication to liver transplantation.