title: Successful Outflow Reconstruction to Salvage Traumatic Hepatic Vein-Caval Avulsion of a Normothermic Machine Ex-Situ Perfused Liver Graft: Case Report and Management of Organ Pool Challenges.
abstract: Donor organ shortage continues to limit the availability of liver transplantation, a successful and established therapy of end-stage liver diseases. Strategies to mitigate graft shortage include the utilization of marginal livers and recently ex-situ normothermic machine perfusion devices. A 59-year-old woman with cirrhosis due to primary sclerosing cholangitis was offered an ex-situ machine perfused graft with unnoticed severe injury of the suprahepatic vasculature due to road traffic accident. Following a complex avulsion, repair and reconstruction of all donor hepatic veins as well as the suprahepatic inferior vena cava, the patient underwent a face-to-face piggy-back orthotopic liver transplantation and was discharged on the 11th postoperative day after an uncomplicated recovery. This report illustrates the operative technique to utilize an otherwise unusable organ, in the current environment of donor shortage and declining graft quality. Normothermic machine perfusion can definitely play a role in increasing the graft pool, without compromising the quality of livers who had vascular or other damage before being ex-situ perfused. Furthermore, it emphasizes the importance of promptly and thoroughly communicating organ injuries, as well as considering all reconstructive options within the level of expertise at the recipient center.
authors.affiliation: From the Senior Clinical Fellows in Hepato-Pancreato-Biliary and Liver Transplant Surgery (PGA, ADD, RJO-R, AF), Royal Free London Hospital NHS Foundation Trust, University College London; Core Surgical Trainee (CH), Department of Oral & Maxillofacial Surgery, King's College Hospital, London; Clinical Research Fellow in Transplant Surgery (DN), Nuffield Department of Surgical Sciences, Oxford Transplant Centre, Oxford; Department of Pharmacy & Forensic Science (SKK), King's College; and Professor of Surgery (MM), Consultant Liver Transplant and HPB Surgeon, Royal Free Hospital, Pond Street, London, UK.
authors.forename: Panagiotis G
authors.initials: PG
authors.lastname: Athanasopoulos
authors.forename: Christopher
authors.initials: C
authors.lastname: Hadjittofi
authors.forename: Arinda Dinesh
authors.initials: AD
authors.lastname: Dharmapala
authors.forename: Rafael Jose
authors.initials: RJ
authors.lastname: Orti-Rodriguez
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ferro
authors.forename: David
authors.initials: D
authors.lastname: Nasralla
authors.forename: Sofia K
authors.initials: SK
authors.lastname: Konstantinidou
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
mesh_terms: D015209:Cholangitis, Sclerosing / Q000150:complications; D005260:Female; D006085:Graft Survival; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D014682:Vena Cava, Inferior / Q000601:surgery*