Atrophy of the Left Graft Secondary to Arterial Inflow Failure in Dual Liver Transplantation.

Hepatic arterial flow may have a profound influence on the regeneration process and intergraft competition in dual graft liver transplant. Here, we report a case of impaired left hepatic arterial flow and left lobe graft atrophy in a dual graft recipient. A 52-year-old male patient with hepatitis C-related liver cirrhosis received the right liver lobe from his daughter together with the left lobe from his brother to get an adequate graft volume (65.1% of standard liver volume). The left lobe graft was orthotopically placed to the recipient's left lobe position. The left hepatic artery of the graft was anastomosed to the common hepatic artery of the recipient, for which the recipient's great saphenous vein was used as an interposition graft. Impaired left hepatic arterial inflow perfusion was observed on postoperative day 7, whereas right hepatic arterial flow and portal and venous flows in both grafts were excellent. The recipient now has a normal life with normal liver function tests. A computed tomography scan taken 1.5 years posttransplant demonstrated complete atrophy of the left graft and compensatory regeneration of the right graft. The left graft atrophy may be directly attributed to left hepatic arterial inflow failure in this case.