Performing a Right Hemihepatectomy Sequentially after Deceased Donor Liver Transplantation - The Solution for a Large-for-size Graft: A Case Report

Background Large-for-size (LFS) is a serious problem that can develop during liver transplantation (LT) and is related to morbidities such as insufficient blood supply causing graft dysfunction or impractical closure of the abdominal wall leading to graft compression. LFS is usually discussed in pediatric LT and is often managed by reducing the size of the graft before implantation. In contrast, only a few cases about managing unexpected LFS during adult LT have been reported, and no case after the vascular anastomosis has been completed has been reported. Case Report A 36-year-old, 43-kg woman underwent an emergency LT using a deceased donor, although the estimated graft/recipient weight ratio was 3.98%. After completing the vascular anastomosis, a severe hepatic venous outflow obstruction from the graft developed due to compression of the inferior vena cava from the hypertrophied right posterior lobe of the graft. We performed a right hemihepatectomy sequentially after LT, and hepatic blood flow recovered sufficiently based on a Doppler sonogram. The postoperative clinical course was uneventful without vascular or ductal complications, and the primary abdominal wall closure was successfully achieved without wound complications. Conclusions Performing a right hemihepatectomy sequentially after completing the vascular anastomosis during LT could be a very simple and effective solution for unexpected LFS during LT.