Elsevier

Transplantation Proceedings

Volume 47, Issue 9, November 2015, Pages 2768-2770
Transplantation Proceedings

9th Congress of the Andalucian Transplantation Society
Case report
Case Report of Relay Liver Transplantation With Graft Infected With Hepatitis B Virus

https://doi.org/10.1016/j.transproceed.2015.09.036Get rights and content

Highlights

  • Thorough biochemical, radiologic, and histologic investigations are needed before relay liver transplantation.

  • Reuse of liver graft for liver transplantation is feasible even in hepatitis B–infected recipients.

  • Technical difficulties and adhesion should not be a contraindication for late relay liver transplantation.

Abstract

Reuse of liver graft for transplantation is extremely uncommon. We report the 1st case of reuse of liver graft from a recipient who had hepatitis B virus (HBV) infection, 11 years after the 1st transplantation. Our relay liver transplantation challenged conventional thinking because of late reuse of graft in the presence of HBV infection. Moreover, both the 1st and the 2nd donors were of advanced age. The key questions were whether the liver graft could be reused safely, especially in the setting of HBV infection, and technical concerns during organ procurement and implantation. The absence of HBV replication was confirmed with negative hepatitis B surface antigen and undetectable serum HBV DNA in the 2nd donor. Based on our experience in managing HBV infection after liver transplantation, we were confident that the adequately suppressed HBV infection in the donor would not jeopardize graft function and that the graft would be able to withstand another ischemia-perfusion injury to continue to function well in our recipient.

Section snippets

Case Presentation

The 1st LT was performed in 2003. The donor liver was procured from a 67-year-old man with a body mass index of 25 kg/m2 who died from intracerebral hemorrhage. It was transplanted to a 49-year-old male patient who suffered from HBV cirrhosis, complicated by hepatic encephalopathy and hepatorenal syndrome. His Model for End-Stage Liver Disease (MELD) score at time of LT was 30. Both the donor and the recipient had blood group O and were rhesus positive. Implantation of the liver graft was

Discussion

Reuse of liver graft for transplantation is rare and is termed “relay transplantation” in the present case report. There were 29 case reports of relay LT in the literature [1], [2], and to the best of our knowledge our patient is the 1st and only relay LT with the use of an HBV liver graft. Brain death of a former LT recipient is uncommon, but intracerebral hemorrhage and cerebral edema are the commonest causes. Most series in literature were reports on early (<1 wk) reuse of liver grafts. The

Cited by (3)

  • Reuse of Living-Donor Liver Graft in Second Recipient with Long-Term Survival

    2018, Transplantation Proceedings
    Citation Excerpt :

    They summarized the indications for successful reuse of liver grafts: all reused grafts should be obtained from young and stable initial donors, excellent graft function in the first recipient, early reuse (within 48 h), short preservation times, biopsy showing minimal preservation injury, negative donor-recipient cross match, AB0 compatibility, and absence of viral, bacterial, and fungal infection. Along with the progress of operative techniques, organ preservation, immunosuppression, and perioperative management, many successful cases of reuse of liver graft have been reported around the world, such as early [1–3] or late [4,5] reuse, reuse of auxiliary liver grafts [6], and reuse of a graft with hepatitis B virus [7]. However, there has been no previous report of reuse of living donor liver graft case.

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