title: Living donor liver transplantation for biliary atresia complicated by situs inversus: technical highlights.
abstract: Living-donor liver transplantation (LDLT) has become an established technique to treat children with end-stage liver disease. Biliary atresia (BA), one of the most common indications for liver transplantation in children, can be associated with situs inversus (SI). In the past, the presence of SI has been considered to be an absolute contraindication for liver transplantation because of the technical difficulties. Recently, some reports of successful diseased-donor liver transplantation in patients with BA complicated by SI have been published; however, few reports of that with LDLT exist. The technical difficulties involved with LDLT for such cases have not been described. Herein, we present 4 successful cases of LDLT for BA with SI. Complex anomalies associated with SI, such as a hepatic artery arising from the supraceliac aorta, a preduodenal portal vein, and absence of the retrohepatic inferior vena cava, increase the technical difficulties involved with the operation. Additional caution is required in LDLT because a living-donor graft has short vessels and the availability of vascular grafts from the donor is limited. In conclusion, LDLT for BA complicated by SI can be managed successfully with technical modifications and scrupulous attention. This series represents the largest reported group of patients with BA complicated by SI who underwent a successful LDLT procedure.
authors.affiliation: Department of Transplantation and Immunology, Kyoto University Faculty of Medicine, Kyoto, Japan. m-ken@dk9.so-net.ne.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Matsubara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Hideya
authors.initials: H
authors.lastname: Kamei
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Mikiko
authors.initials: M
authors.lastname: Ueda
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajama
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis* / Q000601:surgery; D001656:Biliary Atresia / Q000175:diagnosis / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012857:Situs Inversus / Q000175:diagnosis*; D016896:Treatment Outcome