Utilization of a Reduced Graft from a Severely Traumatized Liver: A Case Report and Strategy to Increase Availability of Livers for Transplant

Background: Trauma victims with liver lacerations in the hilum are typically excluded from liver donation. We report a case of a successful liver transplant from a deceased donor with a grade 4 hilar liver laceration. Case Presentation: We used a liver with a high-grade laceration from a 28-year-old brain-dead traffic accident victim. The liver had grade IV lacerations in the right and caudate lobes. In situ split liver technique was applied to control the lacerations after an intraoperative cholangiogram revealed favourable anatomy. The left hemi-liver graft was procured, retaining the entire vena cava and the full length of the main hepatic vasculature. The recipient was a 62-year-old female patient with end-stage liver disease, with a Model for End-Stage Liver Disease-Sodium score of 19. The left lobe graft was transplanted using the standard piggy-back technique. The patient was discharged on postoperative day 7 after an uneventful recovery. At two-month follow-up, she continues to do well, with normal hepatic function and unremarkable imaging studies. Conclusion: This is the first reported case of a successful liver transplant of a severely lacerated liver made possible by the application of split liver techniques. In situ splitting of a severely traumatized liver could permit the utilization of a reduced graft for small recipients.