The patient is a 60-year old man with a history of Hepatitis C cirrhosis complicated by encephalopathy, ascites, variceal bleeding and splenomegaly with thrombocytopenia.
A 42-year old blood group compatible donor was identified in Tennessee. The donor had a history of polycystic kidney disease. The liver showed some small cysts but was otherwise normal. The liver was procured and flushed with Custodiol® HTK, 4 liters in aorta and 2 liters in portal vein with an additional backtable flush of 1 liter. The graft was imported to NY.
The patient underwent orthotopic liver transplantation without venovenous bypass which was uncomplicated. The cold and warm ischemia times were 11 hours and 39 minutes respectively. The biliary reconstruction was duct to duct without a T-tube. In addition a spontaneous splenorenal shut was taken down by left renal vein ligation.
The patient received 4 units of packed red cells, 1 unit cellsaver, 6 units of fresh frozen plasma, and 3500cc of crystalloid. There was good immediate graft function with intraoperative bile production.
The patient did well with excellent graft function and only mild reperfusion injury. The peak serum AST was 2530 IU/L which normalized rapidly and was 30 IU/L by post transplant day 5. He was discharged home on POD 14. He is currently doing well without complications and normal liver function tests at 3 months post transplant.