The use of liver grafts infested with Clonorchis sinensis for orthotopic liver transplantation

In the Orient, millions are known to have Clonorchis sinensis (biliary trematodiasis) infestation. When these infested livers become available as donor organs, there are potentially serious implications that the transplant team would need to consider. We report the use of two such infested livers, one from a cadaveric donor and the other from a live related donor, for orthotopic liver transplantation. The parasite was encountered not only during organ procurement, but also caused early postoperative blockage of the hepatico-jejunostomy splintage tube and cessation of bile flow in the second recipient. Upon follow-up for four and two years, respectively, no other ill effect has been observed in either patient. Repeated examination of stool for ova of C sinensis in both patients during follow-up visits had been negative, indicating that all the parasites probably had been killed by the cold perfusion. In view of the severe shortage of liver grafts and the lack of serious morbidity associated with the use of these infested livers, we have adopted the policy to include these livers for future transplantation. Special considerations and precautions are, however, required during the perioperative period and on long-term follow-up.