Orthotopic liver transplantation with reduced and rotated graft in adult situs inversus recipient: a case report and a review of reported cases

Abstract

Introduction: Situs inversus is a rare congenital anomaly characterized by a mirror-image orientation of abdominal and mostly also thoracic organs. Liver transplantation in these patients is a demanding procedure due to the difficulties pertaining to positioning of the graft and the presence of frequently associated vascular abnormalities. Several reports have been published regarding successful liver transplantation in adult situs inversus recipients with different proposed positions of the graft. Relevant experience remains limited.
Case report: In this paper we present a case of successful transplantation of a reduced-size cadaverous left hemi-liver graft to an adult situs inversus recipient in a 90-degree clockwise rotation. A complex arterial reconstruction was established. A review of published liver transplantations in adult situs inversus recipients along with the techniques employed is provided.
Results: No vascular or spatial problems were encountered using this technique. The graft function is perfect at 27 months from the transplant procedure. The first liver transplantation with a reduced-size left hemi-liver graft from a situs solitus cadaveric donor to the situs inversus adult recipient is presented.
Conclusion: The devised method of 90-degree clockwise rotation provides perfect spatial adjustment. Relatively smaller grafts are to be preferred as they allow maximum flexibility. Vascular conduits should be readily available.