移植技術と研究

Liver Transplantation From Donor With Situs Inversus Totalis: Is It a Safety Procedure?

Abstract

Gustavo Rêgo Coelho, José Francisco Rêgo e Silva Filho, Amaury de Castro e Silva Filho, Luís Eduardo Veras Pinto, Cayo Cesar Goes Texeira and José Huygens Parente Garcia

Background: The situs inversus is a rare condition of unknown cause that occurs in less than 0.1% of the population. A standard operation procedure has not been established for liver transplantation when the graft comes from a donor with situs inversus. Counting with this, there are nine cases of transplant with liver graft from deceased donors with situs inversus totalis reported in literature.

Methods - Case Report: During organs harvesting of a young male, it was found that all organs of the abdominal and thoracic cavities were located in changed positions, as if it were a mirror image, diagnosing the donor with situs inversus totalis. The liver was flushed with standard preservation solution and procured using standard techniques.

The recipient was a female with cirrhosis caused by Wilson’s disease. She was Child-Pugh C and MELD SCORE 32. Hepatectomy was performed using a piggyback technique with preservation of the vena cava after complete liver mobilization.

The liver graft was brought onto the field and rotated 180° in a ventral caudal fashion (backwards), maintaining the largest lobe in the right upper quadrant. Twenty-eight months after transplant, the graft liver function was still normal and there were no biliary complications or rejection reactions.

Conclusion: Liver transplantation using a graft from donor with a situs inversus totalis seems to be a safe surgical procedure.