Liver Transplantation Using Non-Heart Beating Donor: The First Korean Case Report

Suh, Kyung Suk; Kim, Taehoon; Kim, Joohyun; Park, Yang Jin; Shin, Woo Young; Yi, Nam Joon; Ha, Jongwon; Kim, Sang Joon; Lee, Kuhn Uk

Abstract

A liver originating from Maastricht category 4 non-heart-beating donor (NHBD: cardiac death in a brain death donor) was procured and transplanted. Donor was 46 years old female. She was moved to the operation room after 3 times of cardiopulmonary resuscitation. Arrest occurred 15 minutes after stopping ventilation. After 5 min waiting time, the incision was performed. The interval between incision and initiation of donor perfusion was 5 minutes. Warm ischemic time, which is from the withdrawal of support to perfusion, was 25 minutes. Super-rapid technique was used for the donor procedure. The frozen biopsy of the liver was performed before transplantation and macrovesicular and microvesicular fatty change were less than 5% respectively. The cold ischemic time was 6 hours 22 minutes. Orthotopic liver transplantation was performed with the preservation of the recipient caval vein without venovenous bypass. The recipient was 56 years old female. She suffered from cryptogenic liver cirrhosis with refractory ascites. Postoperatively, the early graft function was good. At the post-operative 10th day, Serum total bilirubin was 1.4 mg/dL and aspartic acid transaminase and alanine aminotransferase was 26 IU/L and 20 IU/L respectively. Post operative 10th day liver biopsy was normal. She stayed at the intensive care unit for 6 days. Post-operatively, Tuberculosis (Tb) peritonitis (by the intra-operative omentum tissue culture) was diagnosed and the patient is under Tb medication. This experience suggests that careful donor selection, minimizing warm and cold ischemic time and utilization of histology provide acceptable results of liver transplantation from NHBD.