Massive hepatic artery atherosclerosis of an otherwise suitable donor liver: a case report

• Published in: Transplantation proceedings Vol. 36; no. 5; pp. 1438 - 1441
• Main Authors: Maluf, D, Clark, B.D, Cotterell, A.H, Posner, M.P, Fisher, R.A
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2004; Elsevier Science
• Subjects: Aorta, Abdominal - pathology; Arteriosclerosis - pathology; Arteriosclerosis - surgery; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Brain Death; Cardiology. Vascular system; Female; Hepatectomy - methods; Hepatic Artery - pathology; Hepatic Artery - surgery; Humans; Liver Transplantation - methods; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Middle Aged; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue and Organ Harvesting - methods; Hepatic artery; Human; Digestive system; Liver; Cardiovascular disease; Transplantation; Homotransplantation; Vascular disease; Case study; Treatment; Donor; Surgery; Atherosclerosis; Graft
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2004.05.007

Most of the few reports about hepatic artery disease found in the literature describe hepatic artery aneurysms or hepatic artery calcifications. Atherosclerosis of the hepatic artery is not commonly evaluated during deceased donor liver procurement. Herein we present a case of a stable 47-year-old Caucasian female donor whose liver function tests were within normal limits and a liver biopsy showed less than 5% steatosis. The liver when received at our center appeared grossly unremarkable. Back-table evaluation showed a complete occlusion of the trunk of the proper hepatic artery. The pathology report revealed hepatic occlusion due to arterial atherosclerosis. Transplantation was canceled, and the liver was used for isolated hepatocyte perfusion, revealing <25% hepatocyte viability. Hepatic artery atherosclerosis and patency need to be evaluated at the time of procurement to prevent recipient morbidity due to anesthetic induction, or initiation of a recipient abdominal incision prior to declining the liver graft for this rare finding.