最近移植された多臓器移植患者からの肝移植：症例報告

Liver transplantation from previously transplanted donors is an emerging yet rarely reported strategy to address global organ shortages. This case describes the clinical course and outcome of a liver transplant recipient who received an organ from a multiorgan donor recently submitted to pancreas-kidney transplantation.

A 40-year-old woman with Budd-Chiari syndrome underwent orthotopic liver transplantation. The donor was a 24-year-old male with type 1 diabetes mellitus and end-stage renal disease who had received a pancreas-kidney transplant 10 days before suffering a fatal hemorrhagic stroke. Due to retrohepatic inferior vena cava agenesis and thrombosis in the recipient, a classical caval replacement technique was employed. The patient initially progressed well but developed a biliary anastomotic stricture at 4 months post-transplant. Despite multiple endoscopic procedures, she developed biliary cast syndrome and underwent Roux-en-Y hepaticojejunostomy. Postoperatively, she developed septic shock and died on the 10th postoperative day. Organ donation in this case was conducted in accordance with the ethical standards of the Helsinki Congress and the Istanbul Declaration.

This case supports the feasibility of using livers from recently transplanted donors when stringent selection criteria are applied. It also underscores the technical complexity of liver transplantation in patients with Budd-Chiari syndrome and the significant risk of biliary complications. Organ reuse may represent a valuable approach to expand the donor pool, but it must be carefully weighed against procedural risks and ethical standards.