Side-to-side caval anastomosis in a patient receiving a liver graft from a marginal donor with situs inversus totalis

Highlights • Liver transplantation using a donor with situs inversus totalis is feasible and safe. • The anatomical anomalies in the donor with situs inversus totalis should not be considered a controindication to liver transplantation. • The 1992-Belghiti piggyback technique represents an excellent surgery option for liver transplantation.
Introduction The donor situs inversus totalis status was considered an absolute contraindication to liver transplantation due to the technical difficulties involved. Only in recent years has a very young deceased donor with situs inversus totalis been considered as a potential donor. Presentation of case We herein report a single case of 57-year-old male patient with hepatocellular carcinoma who received a liver transplantation from a 73-year-old woman with situs inversus totalis. Liver was implanted using a 1992-Belghiti piggyback technique positioning the larger hemiliver in the left upper quadrant and the left in the liver fossa. We assisted a good graft reperfusion without surgical or anesthetic problems. His hospital stay was relatively uneventful and he was discharged from hospital on postoperative day 7. At 8 months of follow-up the patient is alive and in good clinical condition. Discussion The donor situs inversus totalis does not require any modification of transplant procedure if the donor–recipient size match permits a comfortable placement of the graft in a standard anatomical position. To the best of our knowledge, this is the first case of liver transplantation with a graft from a “marginal” donor with situs inversus totalis using a 1992-Belghiti piggyback technique. Conclusion The donor situs inversus totalis status should not be considered a contraindication for LT and the piggyback technique should be considered the surgery of choice.