The good results reported for liver transplantation have encouraged a
much wider application of the procedure, broadening the list of indica
tions and increasing the number of candidates. The shortage of organs
for transplantation is a main problem that limits hepatic replacement
in the potential recipients. Consequently, the number of contraindicat
ions for donor selection has been reduced over the last years. Some fa
ctors that were previously thought to preclude successful transplantat
ion have now been relegated to relative contraindications, while other
s are no longer included. This has frequently led to the use of livers
under suboptimal conditions or with anatomical anomalies. This is the
case of donors with abdominal situs inversus. In this article, we rep
ort an orthotopic liver transplantation using a donor with abdominal s
itus inversus. Immunosuppressive protocol following surgery was compos
ed of a classic three-drug therapy (cyclosporine, azathioprine, and pr
ednisolone). The modified piggyback technique was performed over the r
ight suprahepatic vein with orthotopic position of the graft. The graf
t showed good long-term function in the recipient, with a normal hepat
ic biopsy 5 months after the transplantation. There was no patient rea
dmission or other medical problem after a 21/2-year follow-up.