26 June 2019 : Case report
Adult Living Donor Liver Re-Transplant Following Late Pediatric Liver Transplant Failure: A Case Report
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Educational Purpose (only if useful for a systematic review or synthesis)Hamad Al Bahili1AE, Abdullah Al Garni1F, Ibrahim Al Hasan1BD, Yazeed M. Alsebayel2BD*, Maha Al Eid3C, Ahmed Al Zaharani2F, Awad Salem Qahtani1D, Hisham H. Negmi1AE, Nasser Al Masri1F
Am J Case Rep 2019; 20:908-913
BACKGROUND: Re-transplant of a late failing living donor liver graft using another graft from another living donor is a rare occurrence and is associated with high mortality due to the complexity of the procedure. There are only a few such case series reported in the literature, mainly from South Asia and Japan, where living donor liver transplant is commonly performed, and there are no such reports from Western countries.
CASE REPORT: This is a case of living donor liver re-transplant for a 28-year-old recipient whose graft failed 14 years after his primary living donor transplant for primary sclerosing cholangitis. The second transplant was a right-lobe graft obtained from a living donor. The presence of portal vein thrombosis in the setting of high Model for End-Stage Liver Disease (MELD) score added to the complexity of the case. The procedure was concluded successfully with an uneventful post-operative course. The patient was discharged 3 weeks after the procedure. One-year follow-up showed a normally functioning graft.
CONCLUSIONS: Successfully re-transplanting a patient with a failing living donor liver graft from a living donor is possible if sufficient surgical expertise is available and the risk and benefit are carefully considered. This is especially important in countries where a cadaveric graft is difficult to obtain due to organ scarcity.
Keywords: Graft Rejection, Liver Transplantation, Living Donors, Cholangitis, Sclerosing, End stage liver disease, Graft Survival, Reoperation, Risk Factors, Severity of Illness Index
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