LIVER-TRANSPLANT IN COMPLETE SITUS-INVERSUS - A CASE-REPORT

Background. Several technical solutions have been proposed for patient s with situs inversus (SI) needing liver transplantation. This report describes the hepatic replacement in a patient with complete SI with d extrocardia. In the only other reported patient with complete SI the d onor right lobe was placed over the vertebral column and the stomach t o align the donor cava with that of the recipient. Methods. A 45-year- old woman with complete SI, suffering from Laennec's cirrhosis with fr equent upper gastrointestinal hemorrhages, underwent transplantation i n June 1991. The recipient weighed 48.2 kilograms and was 155 centimet ers tall. The donor weighed 77.3 kilograms and was 188 centimeters tal l. The weight of the native liver was 1934 grams, and the donor liver weighed 1595 grams. Results. At hepatectomy of the native liver an int act vena cava was left behind. Donor liver was rotated 90 degrees to t he left, making the donor left lobe point into the left iliac fossa an d the donor right lobe fall into the recipient hepatic fossa. Donor in frahepatic vena cava was sewn end-to-side to the recipient vena cava. Suprahepatic vena cava was oversewn. Donor and recipient hila were wel l aligned, allowing a standard arterial reconstruction and a choledoch oledochostomy. Patient's recovery was uneventful with no problems duri ng the following 6 months. Conclusions. The proposed technique for a p atient with complete SI and dextrocardia offers several advantages: no need to downsize the donor in comparison with the recipient; no need for cutdown of the liver; no risk of kinking of the venous outflow; he patic hila are aligned; and it allows for a standard arterial and bili ary reconstruction. We recommend this technique as a Procedure of choi ce for patients with SI and an intact vena cava.