Pushing the boundaries in liver graft utilisation in transplantation: Case report of a donor with previous bile duct injury repair. (2017)

• Record Type: Journal Article
• Authors: Sultana, Asma; Powell, James J.; Oniscu, Gabriel C.
• Is Part Of: International journal of surgery case reports. Volume 37(2017)
• Page Start: 248
• Page End: 249
• Publication Date: 2017
• Subjects: Extended criteria donor -- Liver transplantation -- Organ procurement -- Bile duct injury; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.06.050
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: First case report on the use of a donor with previous bile duct injury for liver transplantation. Emphasis on careful liver retrieval and backbench preparation, with attention to arterial blood supply. Previous bile duct injury does not preclude use of the liver in orthotopic liver transplantation. Abstract: Introduction: Liver transplantation is a recognised treatment for extensive bile duct injuries with secondary biliary cirrhosis or recurring sepsis. However, there have been no reports of successful liver transplantation from a donor who sustained a previous bile duct injury. Presentation of case: Here we discuss the case of a liver transplant from a 51-year-old brain dead donor who had suffered a Strasberg E1 bile duct injury and had undergone a Roux-en-Y hepaticojejunostomy 24 years prior to donation. The liver was successfully recovered and transplanted into a 56-year-old male recipient with end stage liver disease consequent to alpha 1 antitrypsin deficiency. The graft continues to function well 36 months post-transplant, with normal liver function tests and imaging revealing a patent hepaticojejunostomy. Discussion: The potential associated vascular injuries should be identified during bench preparation whilst the management of biliary reconstruction at the time of transplant should follow the principles of biliary reconstruction in cases with biliary injuries, extending the hilar opening into the left duct. Conclusion: This case highlights the successful utilisation of a post bile duct injury repair liver, employing an experienced procurement team and careful bench assessment and reconstruction.