Left lobe living donor liver transplantation in an adult patient with situs inversus: Technical considerations

Situs inversus (SI) is a rare congenital disorder involving a complete mirror image of the thoracic and abdominal organs. Living donor liver transplantation (LDLT) in SI cases poses particular challenges on account of its technical complexity, and only a few cases have been reported. Here, we present an adult with SI who was managed successfully by LDLT using a left lobe graft. Some technical modifications, including triangulated anastomosis of the hepatic vein, were required but no vascular graft was necessary. Graft function and vascular integrity were excellent throughout the postoperative course, although sepsis secondary to wound infection with methicillin-resistant Staphylococcus aureus developed. In conclusion, LDLT using a left lobe graft is a feasible procedure for patients with SI, even for adults. Therefore, this condition, while rare, should not be a contraindication for LDLT. Meticulous preoperative simulation and planning of the vascular reconstruction are important steps in LDLT for this rare anomaly.