Large Riedel’s lobe and atrophic left liver in a donor - Accept for transplant or call off?

Table 1 Risk factors and outcomes of the two cases

Parameter	Case 1	Case 2
Donor and graft Parameter-type, COD	DBD, ICH	DBD, ICH
Age (yr)	71	73
BMI (kg/m2)	23	25
Past medical history	Hypertension, Previous cholecystectomy for cholecystitis and peritonitis	Hypertension
Liver weight (kg)	2.2	1.8
Recipient parameter
Age (yr)	62	63
Underlying disease	Alcoholic cirrhosis, ascites, SBP, regular paracentesis	Alcoholic cirrhosis
Lab MELD	22 points	17 points
Transplantation surgery	7L Ascites, thrombectomy for portal vein thrombosis Grade 2	Minimal ascites
	Modified Piggy back, side-to-side	Modified Piggy back, side-to-side
	Donor CHA-GDA patch to Recipient RHA from SMA (GDA patch)	Donor CHA-GDA patch to Recipient CHA-GDA patch
	Duct – to – Duct over plastie	Duct – to – Duct
	5 RBC, 8 FFP, no platelets or cryo	2 RBC, no FFP, no platelets or cryo
Outcome	Immediate liver function and extubation	Immediate liver function and extubation
	Acute kidney injury without renal replacement therapy	One episode of acute cellular rejection
	Hospital stay: 12 d	Hospital stay: 26 d
	One local readmission for diarrhea within first 3 mo	Biliary reconstruction for Anastomotic stricture after 14 mo
		One episode of acute cellular rejection after 19 mo
Follow up	12 mo, alive, normal liver function	22 mo, alive, normal liver function

DBD: Donation after brain death; ICH: Intracranial haemorrhage; COD: Cause of death; MELD: Model of end liver disease; SBP: Spontaneous bacterial peritonitis; CHA: Common hepatic artery; GDA: Gastroduodenal artery; SMA: Supra-mesenteric artery; RBC: Red blood cell concentrate; FFP: Fresh frozen plasma.