title: Side-to-side caval anastomosis in a patient receiving a liver graft from a marginal donor with situs inversus totalis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy. Electronic address: tomanzia@libero.it.
authors.forename: Tommaso Maria
authors.initials: TM
authors.lastname: Manzia
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Tariciotti
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Angelico
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Toti
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Anselmo
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tisone
keywords: Liver transplantation; Marginal donor; Piggyback technique; Situs inversus totalis