Graft Retrieval for Liver Transplant in a Donor With Giant Thoracoabdominal Aortic Aneurysm.

Levi Sandri, Giovanni Battista; Guglielmo, Nicola; Berardi, Giammauro; Ettorre, Giuseppe Maria

Liver transplant is a lifesaving treatment option for end-stage liver disease in those with or without hepatocellular carcinoma. Organ shortage is currently the main limitation to liver transplant in many countries worldwide, with fewer donors than patients waiting for transplant. Different solutions have been proposed, including the use of marginal grafts, living donors, and machine perfusion. Potential organs are sometimes discarded due to technical difficulties that may hamper the success of their retrieval and eventual transplant. Here, we present the case of a 69-year-old man with a history of cardiac and pulmonary disease who was considered a potential organ donor after brain death. According to the patient's history, a computed tomography before acceptance was required. The scan revealed a giant thoracoabdominal aortic aneurysm. The donor had previous cardiac surgery with sternotomy and a talcage of the right pleural space. The 2 renal arteries were also unusable because of spread calcifications and involvement by the aneurism. We decided to cannulate the superior mesenteric vessels. Liver transplant was uneventful, and the recipient had no vascular complications, as shown by Doppler ultrasonography performed on days 1, 3, and 7. Length of hospitalization was 14 days. Organ shortages for transplant seemed to have worsened during the COVID-19 period. Nonetheless, the condition of oncology patients can worsen if surgical treatments are delayed. Rearrangements of resources require adaptations in clinical practice.